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Endocrine Pathology
Published in: Endocrine Pathology 2/2013

Open Access 01-06-2013

Double, Synchronous Pituitary Adenomas Causing Acromegaly and Cushing’s Disease. A Case Report and Review of Literature

Authors: Grzegorz Zieliński, Maria Maksymowicz, Jan Podgórski, Włodzimierz T. Olszewski

Published in: Endocrine Pathology | Issue 2/2013

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Abstract

Double pituitary adenomas are very rare and present up to 1 % of pituitary adenomas in unselected autopsy series and up to 2 % in large surgical series. We report a case of a 47-year-old man presented slight clinical features of acromegaly with 2 years duration. Endocrine evaluation confirmed active acromegaly and revealed adrenocorticotropin hormone-dependent hypercortisolemia. Preoperative magnetic resonance imaging of the pituitary demonstrated clearly separated double microadenomas with different intensity. The patient underwent transsphenoidal surgery and both tumors were completely removed and were fixed separately. The histological and ultrastructural examination confirmed coincidence of the double, clearly separated pituitary adenomas in one gland. Postoperative function of the hypothalamo-hypophyseal axis was normalized. We conclude from this case and a literature review that double endocrinologically active pituitary adenomas leading to acromegaly and Cushing’s disease may occur. Additionally, a review of the literature regarding multiple pituitary adenomas has also been performed.
Literature
1.
Asa SL (2011) Tumors of the Pituitary Gland. AFIP Atlas of Tumor Pathology. IV Series Armed Forces Institute of Pathology. Washington DC.
2.
Lloyd RJ, Kovacs K, Young WF Jr, Farrell WE, Asa SL, Trouillas J, Kontogeorgos G, Sano T, Scheithauer BW, Horvath E, Watson RE, Lindell EP, Barkan AL, Saeger W, Nose V, Osamura RY, Ezzat S, Yamada S, Roncaroli F, Lopes MBS & Vidal Ruibal S (2004) Tumours of the pituitary. In: Pathology & genetics. Tumours of endocrine organs, pp 9–48. eds. RA DeLellis, RV Lloyd, PU Heitz, C Eng. Lyon: International Agency for Research and Cancer (IARC),
3.
Ho D M-T, Hsu C-Y, Ting L-T, Chiang H (2001) Plurihormonal pituitary adenomas: immunostaining of all pituitary hormones is mandatory for correct classification. Histopathology 39:310–319.PubMedCrossRef
4.
Kovacs K, Horvath E, Stefaneanu L, Bilbao J, Singer W, Muller PJ, Thapar K, Stone E (1998) Pituitary adenoma producing growth hormone and adrenocorticotropin: a histological, immunocytochemical, electron microscopic, and in situ hybridization study. Case report. J Neurosurg 88:1111–1115.PubMedCrossRef
5.
Scheithauer BW, Horvath E, Kovacs K, Laws ER Jr, Randall RV, Ryan N (1986) Plurihormonal pituitary adenomas. Semin Diagn Pathol 3:69–82.PubMed
6.
Kontogeorgos G, Scheithauer BW, Horvath E, Kovacs K, Lloyd RV, Smyth HS, Rologis D (1992) Double adenomas of the pituitary: a clinicopathological study of 11 tumors. Neurosurgery 31:840–849.PubMedCrossRef
7.
Andrioli M, Giraldi FP, Losa M, Terreni M, Invitti C, Cavagnini F (2010) Cushing’s disease due to double pituitary ACTH-secreting adenomas: the first case report. Endocrine J 57:833–837.CrossRef
8.
Kontogeorgos G, Kovacs K, Horvath E, Scheithauer BW (1991) Multiple adenomas of the human pituitary. A retrospective autopasy study with clinical implications. J Neurosurg 74:243–247.PubMedCrossRef
9.
Buurman H, Saeger W (2006) Subclinical adenomas in postmortem pituitaries: classification and correlations to clinical data. Eur J Endocrinol 154:753–758.PubMedCrossRef
10.
Kim K, Yamada S, Usui M, Sano T (2004). Preoperative identification of clearly separated double pituitary adenomas. Clin Endocrinol (Oxf) 61:26–30.CrossRef
11.
Sano T, Horiguchi H, Xu B, Li C, Hino A, Sakaki M, Kannuki S, Yamada S (1999) Double pituitary adenomas: six surgical cases. Pituitary 1:243–250.PubMedCrossRef
12.
Ratliff JK, Oldfield EH (2000) Multiple pituitary adenomas in Cushing’s disease. J Neurosurg 93:753–761.PubMedCrossRef
13.
Syro LV, Horvath E, Kovacs K (2000) Double adenoma of the pituitary: a somatotroph adenoma colliding with a gonadotroph adenoma. J Endocrinol Invest 23:37–41.PubMed
14.
Kannuki S, Matsumoto K, Sano T, Shintani Y, Bando H, Saito S (1996) Double pituitary adenoma—two case reports. Neurol Med Chir 36:818–821.CrossRef
15.
Meij BP, Lopes MB, Vance ML, Thorner MO, Laws ER (2000) Double pituitary lesions in three patients with Cushing’s disease. Pituitary 3:159–168.PubMedCrossRef
16.
McKelvie PA, McNeill P (2002) Double pituitary adenomas: a series of three patients. Pathology 34:57–60.PubMedCrossRef
17.
Rotondo F, Khatun N, Scheithauer BW, Horvath E, Marotta TR, Cusimano M, Kovacs K (2011) Unusual double pituitary adenoma: a case report. Pathol Int 61:42–46.PubMedCrossRef
18.
Thodou E, Kontogeorgos G, Horvath E, Kovacs K, Smyth HS, Ezzat S (1995) Asynchronous pituitary adenomas with differing morphology. Arch Pathol Lab Med 119:748–750.PubMed
19.
Pellegrini-Bouiller I, Manrique C, Gunz G, Grino M, Zamora AJ, Figarella-Branger D, Grisoli F, Jaquet P, Enjalbert A (1999) Expression of the members of the Ptx family of transcription factors in human pituitary adenomas. J Clin Endocrinol Metab 84:2212–2220.PubMedCrossRef
20.
21.
Jastania RA, Alsaad KO, Al-Shraim M, Kovacs K, Asa SL (2005) Double adenomas of the pituitary: transcription factors Pit-1, T-pit, and SF-1 identify cytogenesis and differentiation. Endocr Pathol 16:187–194.PubMedCrossRef
22.
Invitti C, Pecori Giraldi F, De Martin M, Cavagnini F (1999) Diagnosis and management of Cushing’s syndrome: results of an Italian multicentre study. J Clin Endocrinol Metab 84:440–448.PubMedCrossRef
23.
Tabarin A, Laurent F, Catargi B, Olivier-Puel F, Lescene R, Berge J, Galli FS, Drouillard J, Roger P, Guerin J (1998) Comparative evaluation of conventional and dynamic magnetic resonance imaging of the pituitary gland for the diagnosis of Cushing’s disease. Clin Endocrinol 49:293–300.CrossRef
24.
Patronas N, Bulakbasi N, Stratakis CA, Lafferty A, Oldfield EH, Doppman J, Nieman LK (2003) Spoiled gradient recalled acquisition in the steady state technique is superior to conventional postcontrast spin echo technique for magnetic resonance imaging detection of adrenocorticotropin-secreting pituitary tumors. J Clin Endocrinol Metab 88:1565–1569.PubMedCrossRef
25.
Ikeda H, Abe T, Watanabe K (2010) Usefulness of composite methionine-positron emission tomography/3.0-tesla magnetic resonance imaging to detect the localization and extent of early stage Cushing adenoma. J Neurosurg 112:750–755.PubMedCrossRef
26.
Stobo DB, Lindsay RS, Connell JM, Dunn L, Forbes KP (2011) Initial experience of 3 Tesla versus conventional field strength magnetic resonance imaging of small functioning pituitary tumours. Clin Endocrinol 75:673–677.CrossRef
27.
Watson JC, Shawker TH, Nieman LK, Devroom HL, Doppman JL, Oldfield EH (1998) Localization of pituitary adenomas by using intraoperative ultrasoound pituitary in patients with Cushing’s disease and no demonstrable tumor on magnetic resonance imaging. J Neurosurg 89:927–932.PubMedCrossRef
28.
Arita K, Kurisu K, Tominaga A, Kawamoto H, Iida K, Mizoue T, Pant B, Uozumi T (1998) Trans-sellar color Doppler ultrasonography during transsphenoidal surgery. Neurosurgery 42:81–85.PubMedCrossRef
29.
Giustina A, Barkan A, Chanson P, Grossman A, Hoffman A, Ghigo E, Casanueva F, Colao A, Lamberts S, Sheppard M, Melmed S, European Neuroendocrine Association. (2008) Guidelines for the treatment of growth hormone excess and growth hormone deficiency in adults. J Endocrinol Invest 31:820–838.PubMed
30.
Biller BM, Grossman AB, Stewart PM, Melmed S, Bertagna X, Bertherat J, Buchfelder M, Colao A, Hermus AR, Hofland LJ, Klibanski A, Lacroix A,Lindsay JR, Newell-Price J, Nieman LK, Petersenn S, Sonino N, Stalla GK, Swearingen B, Vance ML, Wass JA, Boscaro M (2008) Treatment of adrenocorticotropin-dependent Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 93:2454–2462.PubMedCrossRef
31.
Egensperger R, Scheithauer BW, Horvath E, Kovacs K, Giannini C, Young WFJ, Lloyd R, Atkinson J, Nippoldt TB (2001) Cushing’s disease due to plurihormonal adrenocorticotropic hormone and gonadotropin-producing pituitary adenoma. Acta Neuropathol 102:398–404.PubMed
32.
Ikeda H, Yoshimoto T, Kovacs K, Horvath E (1995) Cushing’s disease due to female gonadotroph adenoma of the pituitary. Clin Endocrinol 43:383–386.CrossRef
33.
Blevins LS Jr, Hall GS, Madoff DH, Laws ER Jr, Wand GS (1992) Case report: acromegaly and Cushing’s disease in a patient with synchronous pituitary adenomas. Am J Med Sci 304:294–297.PubMedCrossRef
34.
Arita K, Uozumi T, Kuwabara S, Mukada K, Kawamoto K, Takechi A, Onda J, Hara H, Egusa G (1991) A case of pituitary adenoma producing both growth hormone (GH) and adrenocorticotropic hormone (ACTH). Endocrinol Jpn 31:271–278.CrossRef
35.
Kageyama K, Nigawara T, Kamata Y, Teriu K, Anzai J, Sakihara S, Suda T (2002) A multihormonal pituitary adenoma with growth hormone and adrenocorticotropic hormone production, causing acromegaly and Cushing’s disease. Am J Med Sci 324:326–330.PubMedCrossRef
36.
Tahara S, Kurotani R, Ishii Y, Sanno N, Teramoto A, Osamura RY (2002) A case of Cushing’s disease caused by pituitary adenoma producing adrenocorticotropic hormone and growth hormone concomitantly: aberrant expression of transcription factors NeuroD1 and Pit-1 as a proposed mechanism. Mod Pathol 15:1102–1105.PubMedCrossRef
37.
Gorden P, Becker CE, Levey GS, Roth J (1968) Efficacy of aminoglutethimide in the ectopic ACTH syndrome. J Clin Endocrinol Metab 28:921–923.PubMedCrossRef
38.
Rosenzweig JL, Lawrence DA, Vogel DL, Costa J, Gorden P (1982) Adrenocorticotropin-independent hypercortisolemia and testicular tumors in a patient with a pituitary tumor and gigantism. J Clin Endocrinol Metab 55:421–427.PubMedCrossRef
39.
Young WF Jr, Carney JA, Musa BU, Wulffraat NM, Lens JW, Draxhage HA (1989) Familial Cushing’s syndrome due to primary pigmented nodular adrenocortical disease: reinvestigation 50 years later. N Engl J Med 321:1659–1664.PubMedCrossRef
40.
Oyama K, Yamada S, Hukuhara N, Hiramatsu R, Taguchi M, Yazawa M, Matsuda A, Ohmura E, Imai Y (2006) FSH-producing macroadenoma associated in a patient with synchronous pituitary adenomas. Neuro Endocrinol Lett 27:733–736.PubMed
41.
Woosley RE (1983) Multiple secreting microadenomas as a possible cause of selective transsphenoidal adenomectomy failure. Case report. J Neurosurg 58:267–269.PubMedCrossRef
42.
Coire CI, Smyth HS, Rosso D, Horvath E, Kovacs K (2010) A double pituitary adenoma presenting as a prolactin-secreting tumor with partial response to medical therapy. Case report. Endocr Pathol 21:135–138.PubMedCrossRef
Metadata
Title
Double, Synchronous Pituitary Adenomas Causing Acromegaly and Cushing’s Disease. A Case Report and Review of Literature
Authors
Grzegorz Zieliński
Maria Maksymowicz
Jan Podgórski
Włodzimierz T. Olszewski
Publication date
01-06-2013
Publisher
Springer US
Published in
Endocrine Pathology / Issue 2/2013
Print ISSN: 1046-3976
Electronic ISSN: 1559-0097
DOI
https://doi.org/10.1007/s12022-013-9237-z

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