Abstract
A 24-year-old woman with a large pituitary adenoma had amenorrhea and galactorrhea, but no physical stigmata of acromegaly despite slightly elevated serum growth hormone (GH) and normal serum prolactin (PRL) levels. Subtotal removal of the tumor cured galactorrhea and resulted in normalization of serum GH concentration. The question is raised whether amenorrhea and galactorrhea were related to excessive GH production in this patient. Absence of acromegaly might have been due to the short duration of the disease. The tumor was a chromophobic, periodic acid-Schiff-negative adenoma. Immunocytochemistry and in situ hybridization revealed focal GH immunoreactivity and diffuse, weak signal for GH messenger RNA. By electron microscopy, the tumor showed no features of GH or PRL-producing adenomas. Two different cell types could be distinguished: the majority were similar to null cells, whereas a small number of cells resembled somatotrophs and lactotrophs, possessing many secretory granules and exhibiting exocytosis. On the basis of its ultrastructure, this tumor can be classified as an atypical acidophil cell line adenoma in which adenomatous null cells transformed to the differentiated cells capable of producing GH.
Similar content being viewed by others
References
Daughaday WH. The adenohypophysis. In: Williams RH, ed. Textbook of endocrinology, 6th ed. Philadelphia: Saunders, 1981: 111–113.
Fradkin JE, Eastman RC, Lesniak MA, Roth J. Specificity spillover at the hormone receptor—exploring its role in human disease. N Engl J Med 320:640–645, 1989.
Horvath E, Kovacs K. The adenohypophysis. In: Kovacs K, Asa SL, eds. Functional endocrine pathology. Boston: Blackwell Scientific Publications, 1991:245–281.
Klibanski A, Zervas NT, Kovacs K, Ridgvvay EC. Clinically silent hypersecretion of growth hormone in patients with pituitary tumors. J Neurosurg 66:806–811, 1987.
Kontogeorges C, Horvath E, Kovacs K, Killinger DW, Smyth HS. Null cell adenoma of the pituitary with features of plurihormonality and plurimorphous differentiation. Arch Pathol Lab Med 115:61–64, 1991.
Kovacs K, Asa SL, Horvath E, Ryan N, Singer W, Killinger DW, Smyth HS, Scheithauer BW, Ebersold MJ. Null cell adenomas of the pituitary: attempts to resolve their cytogenesis. In: Lechago J, Kameya T, eds. Endocrine pathology update. Philadelphia: Field and Wood, 1990: 17–31.
Kovacs K, Lloyd R, Horvath E, Asa SL, Stefaneanu L, Killinger DW, Smyth HS. Silent somatotroph adenomas of the human pituitary. A morphologic study of three cases including immunocytochemistry, electron microscopy, in vitro examination, and in situ hybridization. Am J Pathol 134:345–53, 1989.
Lloyd RV. In situ hybridization in endocrine pathology. Endocr Pathol 2:1–3, 1991.
Pagesy P, Li JY, Kujas M, Peillon F, Delalande O, Visot A, Derome P. Apparently silent somatotroph adenomas. Pathol Res Pract 187:950–956, 1991.
Pestell R, Herington A, Best J, Boolell M, McKelvie P, Arnott R, Alford F. Growth hormone excess and galactorrhea without acromegalic features. Case reports. Br J Obstet Gyaenecol 98:92–97, 1991.
Tourniaire J, Trouillas J, Chalendar D, Bonneton-Emptoz A, Goutelle A, Girod C. Somatotrophic adenoma manifested by garactorrhea without acromegaly. J Clin Endocrinol Metab 61:451–453, 1985.
Trouillas J, Sassolas G, Loras B, Velkeniers B, Raccurt M, Chotard L, Berthezene F, Tourniaire J, Girod C. Somatotrophic adenomas without acromegaly. Pathol Res Pract 187:943–949, 1991.
Yamada S, Sano T, Stephancanu L, Kovacs K, Aiba T, Sawano S, Shishiba Y. Endo crine and morphologic study of a clinically silent somatotroph adenoma of the human pituitary. J Clin Endocrinol Metab (in press).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Yamada, S., Stefaneanu, L., Horvath, E. et al. Morphologically unclassified GH-producing adenoma showing galactorrhea without acromegaly. Endocr Pathol 4, 34–39 (1993). https://doi.org/10.1007/BF02914487
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF02914487