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Two-step development of a pituitary adenoma: From hyperprolactinemic syndrome to Cushing’s disease

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Abstract

In this report we describe the case of a young female patient with amenorrhea-galactorrhea syndrome apparently due to pituitary PRL-secreting adenoma who, after three years of dopaminergic therapy without any shrinkage of the tumor, developed true Cushing’s disease. Progression from hyperprolactinemia to hypersecretion of ACTH has been rarely described and it may be due to different possibilities. However, histopathological and immunohistochemical studies of the adenoma showed a pattern of PRL negative and ACTH positive cells, excluding mixed pituitary tumor. In order to explain the progression from hyperprolactinemia with amenorrhea-galactorrhea to an ACTH hypersecretion syndrome, it must be hypothesized either pituitary stalk compression or the influence of paracrine regulation factor(s) (such as Galanine) due to an “initially silent” corticotropinoma. This case confirms that the presence of hyperprolactinemia in a patient with pituitary tumor and amenorrhea-galactorrhea syndrome is insufficient to confidently conclude for prolactinoma. Furthermore, it underlines the importance both of clinically monitoring the patient with prolactin pituitary adenoma if dopaminergic therapy does not reduce tumor volume, and of accurately and repeatedly measuring the other pituitary hormonal secretions.

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References

  1. Tolis G., Bertrand G., Carpenter S., McKenzie J. Acromegaly and galactorrhea-amenorrhea with two pituitary adenomas secreting growth hormone or prolactin. Ann. Intern. Med. 89: 345, 1978.

    Article  PubMed  CAS  Google Scholar 

  2. Powers S., Wilson C. Simultaneously occurring prolactinomas. J. Neurosurg. 55: 124, 1981.

    Article  PubMed  CAS  Google Scholar 

  3. Woosley R. Multiple secreting microadenomas as a possible cause of selective transphenoidal adenomectomy failure. J. Neurosurg. 58: 267, 1983.

    Article  PubMed  CAS  Google Scholar 

  4. Wynne A.G., Scheithauer B.W., Young W.F., Kovacs K., Ebersold M.J., Horvath E. Coexisting corticotroph and lactotroph adenomas: case report with reference to the relationship of corticotropin and prolactin excess. Neurosurgery 30: 919, 1992.

    Article  PubMed  CAS  Google Scholar 

  5. Kontogheorgos G., Kovacs K., Horvath E., Scheithauer B.W. Multiple adenomas of the human pituitary: a retrospective autopsy study with clinical implications. J. Neurosurg. 74: 243, 1991.

    Article  Google Scholar 

  6. Kontogheorgos G., unpublished data. In: Wynne A.G., Scheithauer B.W., Young W.F., Kovacs K., Ebersold M.J., Horvath E. (Eds.), Coexisting corticotroph and lactotroph adenomas: case report with reference to the relationship of corticotropin and prolactin excess. Neurosurgery 30: 919, 1992.

  7. Berthezene F., Mornex R., Boucher M., Fournier G., Claustrat B. Evolution en deux temps d’un adenoma hypophysarie: syndrome amenorrhee-galactorrhee puis maladie de Cushing. Rev. Oto. Neuro. Ophtalm. 46: 295, 1974.

    CAS  Google Scholar 

  8. Sassolas G., Trouillas J., Treluyer C., Perrin G. Management of nonfunctioning pituitary adenomas. Acta Endocrinol. (Copenh.) 129(Suppl. 1): 21, 1993.

    Google Scholar 

  9. Besser M. Criteria for medical as opposed to surgical treatment of prolactinomas. Acta Endocrinol. 129(Suppl. 1): 27, 1993.

    PubMed  Google Scholar 

  10. Tucker H.S., Grubb S.R., Wigand J.P., Watlington CO., Blackard W.G., Becker D.P. The treatment of acromegaly by transsphenoidal surgery. Arch. Intern. Med. 140: 795, 1980.

    Article  PubMed  CAS  Google Scholar 

  11. Li J., Stefaneanu L., Kovacs K., Horvath E., Smyth H.S. Growth hormone (GH) and prolactin (PRL) gene expression and immunoreactivity in GH- and PRL-producing human pituitary adenomas. Virchows Arch. (A) 422: 193, 1993.

    Article  CAS  Google Scholar 

  12. Horn K., Erhardt F., Fahlbusch R., Pickardt C.R., Werder K.V., Scriba P.C. Recurrent goiter, hyperthyroidism, galactorrhea and amenorrhea due to a thyrotropin and prolactin producing pituitary tumor. J. Clin. Endocrinol. Metab. 43: 137, 1976.

    Article  PubMed  CAS  Google Scholar 

  13. Muller D.A., Finck R., Werder K.V., Scriba P.C. Hypersecretion of ACTH, growth hormone and prolactin in a patient with pituitary adenoma. Acta Endocrinol. (Copenh.) 87: 4, 1978.

    Google Scholar 

  14. Bugalho M.J., Nunes J.F., Sobrinho L.G., Medina E., Campos J.A., da Silva C.G., Clode A.L. Multihormonal response to CRH in a patient with Cushing syndrome and a pituitary adenoma producing ACTH and GH. Acta Endocrinol. (Copenh.) 128: 289, 1993.

    CAS  Google Scholar 

  15. Sherry S.H., Guay A.T., Lee A.K., Hedley-Whyte T., Federman M., Freidberg S.R., Woolf P.D. Concurrent production of adrenocorticotropin and prolactin from two distinct cell lines in a single pituitary adenoma: a detailed immunohistochemical analysis. J. Clin. Endocrinol. Metab. 55: 947, 1982.

    Article  PubMed  CAS  Google Scholar 

  16. Yamaji T., Ishibashi M., Teramoto A., Fukushima T. Prolactin secretion by mixed ACTH-prolactin pituitary adenoma cells culture. Acta Endocrinol. (Copenh.) 108: 456, 1985.

    CAS  Google Scholar 

  17. Shulte H.M., Allolio B., Gunther R.W., Benker G., Winkelmann W., Ohnhaus E.E. Selective bilateral and simultaneous catheterization of the inferior petrosal sinus: CRF stimulates prolactin secretion from ACTH-producing microadenomas in Cushing’s disease. Clin. Endocrinol. (Oxf.) 28: 289, 1988.

    Article  Google Scholar 

  18. Mahler C., Verhelst J., Klaes R., Trouillas J. Cushing’s disease and hyperprolactinemia due to a mixed ACTH-and prolactin-secreting pituitary macroadenoma. Pathol. Res. Pract. 187: 598, 1991.

    Article  PubMed  CAS  Google Scholar 

  19. Yamaji T., Ishibashi M., Teramoto A., Fukushima T. Hyperprolactinemia in Cushing’s disease and Nelson’s syndrome. J. Clin. Endocrinol. Metab. 58: 790, 1984.

    Article  PubMed  CAS  Google Scholar 

  20. Sakurai T., Seo H., Yamamoto N., Nagaya T., Nakane T., Kuwayama A., Kageyama N., Matsui N. Detection of mRNA of prolactin and ACTH in clinically nonfunctioning pituitary adenomas. J. Neurosurg. 69: 653, 1988.

    Article  PubMed  CAS  Google Scholar 

  21. Raffel C., Boggan J.E., Eng L.F., Davis R.L., Wilson C.B. Pituitary adenomas in Cushing’s disease: do they arise from the intermediate lobe? Surg. Neurol. 30: 125, 1988.

    Article  PubMed  CAS  Google Scholar 

  22. Vrontakis M.E., Torsello A., Friesen G.H. Galanin J. Endocrinol. Invest., 14: 785, 1991.

    Article  PubMed  CAS  Google Scholar 

  23. Hsu D.W., Hooi S.C., Hedley-White E.T., Strauss R.M., Kaplan L.M. Coexpression of Galanin and adrenocorticotropic hormone in human pituitary and pituitary adenomas. Am. J. Pathol. 138: 897, 1991.

    PubMed Central  PubMed  CAS  Google Scholar 

  24. Invitti C., Pecori Giraldi F., Tagliaferri A., Scacchi M., Dubini A., Cavagnini F. Enhanced prolactin responsiveness to galanin in patient with Cushing’s disease. Clin. Endocrinol. (Oxf.) 39: 213, 1993.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Unità di Endocrinologia, Dip. di Fisiopatologia Clinica, Università di Firenze, Firenze, Italy

    R. G. Gheri M.D. & M. L. E. Luisi

  2. Divisione di Medicina, Università di Firenze, Firenze, Italy

    W. Boddi, J. Olivotto & C. Nozzoli

  3. Divisione di Neurochirurgia, Università di Firenze, Firenze, Italy

    F. Ammannati, L. Bordi & P. Mennonna

  4. Istituto di Anatomia Patologica, Università di Firenze, Azienda Ospedaliera Careggi, Firenze, Italy

    A. Franchi

Authors
  1. R. G. Gheri M.D.
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  2. W. Boddi
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  3. F. Ammannati
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  4. J. Olivotto
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  5. C. Nozzoli
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  6. A. Franchi
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  7. L. Bordi
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  8. M. L. E. Luisi
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  9. P. Mennonna
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Gheri, R.G., Boddi, W., Ammannati, F. et al. Two-step development of a pituitary adenoma: From hyperprolactinemic syndrome to Cushing’s disease. J Endocrinol Invest 20, 240–244 (1997). https://doi.org/10.1007/BF03346911

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  • DOI: https://doi.org/10.1007/BF03346911

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