ABSTRACT
Objective. We developed a bibliographic research of this rarely and highly aggressive entity, showing our experience and taking into account the special case of one patient, who developed an extremely aggressive disease. Description. Patient of 71 years that consults our department for left cavernous syndrome associated with moderate headache and bilateral visual accuracy diminish. Pituitary IRM was performed showing a homogeneous selar tumor that causes slight mass effect towards optic quiasm. Both cavernous sinuses were compromised. Intervention.Trasfenoidal surgery was performed, reaching the diagnosis of acidophil stem cell adenoma. The patient is dismissed. One week later and because of the development of sudden visual loss she was admitted once again. Pituitary IRM was performed showing a massive growth of the known lesion, requiring transcranial approach. Important mass reduction was achieved but our patient evolution was erratic. Three weeks after surgery we decided to repeat the IRM where we discovered the great mass reduction achieved in the second surgery did not reflect the voluminous lesion shown. One week later the patient died. Conclusion. Acidophil stem cell adenomas of the pituitary gland are mixed PRL/GH lesions, but because its immaturity non functional secreting hormones are produced; this is why these patients do not express physiognomic changes. We should think of this pathology in any pituitary tumor with low PRL-GH expression and few physiognomic changes, and aggressive natural evolution.
Subject(s)
Adenoma, Acidophil , Neoplasms , Stem CellsSubject(s)
Female , Humans , Middle Aged , Acromegaly , Adenoma, Acidophil , Human Growth Hormone , Insulin-Like Growth Factor I , Pituitary Neoplasms , Acromegaly , Adenoma, Acidophil/diagnosis , Adenoma, Acidophil/physiopathology , Adenoma, Acidophil/surgery , Follow-Up Studies , Magnetic Resonance Imaging , Pituitary Neoplasms , Time FactorsABSTRACT
Goiter is present in 25-50% of patients with acromegaly, which probably results from IGF- I stimulation of thyroid cell growth. These goiters are usually non-toxic but there have been well documented cases of co-existent hyperthyroidism and acromegaly. Graves disease with acromegaly has been rarely reported compared with the other type of hyperthyroidism due to increased tumoral secretion of TSH. We experienced a 44-year-old woman who presented with Graves disease and acromegaly. Basal serum GH and IGF-I concentrations were 10.8 pg/L and 571.82 ng/mL, respectively (reference value: (5 mg/L and 130-354 ng/mL, respectively). GH was not suppressed less than 2 pg/L during oral glucose loading test. GH was stimulated by TRH. Postcontrast sellar MRI demonstrated ovoid-shaped low signal intensity nodule measuring O.8 cm in diameter in left side of pituitary gland. Thyroid scan(131I) showed enlarged thyroid with increased radioiodine uptake (61.3%). Histologic examination showed acidophilic adenoma. GH and prolactin were positive on immunohistochemical staining. GH was suppressed less than 2.26 mg/L by oral glucose loading following operation. The patient has been followed with antithyroid drug(PTU) medication after operation(TSA).
Subject(s)
Adult , Female , Humans , Acromegaly , Adenoma, Acidophil , Glucose , Goiter , Graves Disease , Hyperthyroidism , Insulin-Like Growth Factor I , Magnetic Resonance Imaging , Pituitary Gland , Prolactin , Thyroid GlandABSTRACT
El diagnóstico de acromegalia se ha basado tradicionalmente en los niveles de hormona de crecimiento (GH) después de una carga de glucosa por vía oral (CGO). Esta prueba ha sido reemplazada paulatinamente con la estimación de la concentración del factor de crecimiento insulinoide (IGF-I) conocido como somatomedina C, ya que parece reflejar más directamente la acción de la GH, lo que a su vez podría constituir un mejor indicador de la actividad clínica en la acromegalia. Se estudiaron 47 pacientes acromegálicos en los que se realizó una CGO como parte del protocolo diagnóstico, midiéndose la concentración basal de IGF-I y GH; esta última también se midió en las demás muestras de sangre. Los pacientes fueron sometidos a cirugía transesfenoidal y el diagnóstico se confirmó histológicamente. Los niveles de IGF-I fueron altos en todos excepto en uno, lo que representa un valor predictivo de 98.7 por ciento. La concentración de GH estuvo elevada en 31 pacientes, lo cual significa un valor predictivo de 65.9 por ciento. Se concluye que la determinación de IGF-I, o comatomedina C, es una prueba diagnóstica confiable en la acromegalia y tiene ventaja adicional de un menor costo.
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Acromegaly/diagnosis , Somatomedins , Insulin-Like Growth Factor I , Growth Hormone/analysis , Adenoma, Acidophil/surgeryABSTRACT
Two cases of acidophil adenoma of the pituitary causing sudden blindness from pituitary apoplexy are presented. The tumours had been clinically silent, without producing any symptoms of endocrine dysfunction. Radiological evidence was very conclusive. Transfrontal craniotomy with decompression resulted in quick and dramatic visual improvement. The interesting syndrome of clinical manifestations is discussed.
Subject(s)
Adenoma, Acidophil/complications , Adult , Blindness/etiology , Fundus Oculi , Humans , Male , Middle Aged , Pituitary Apoplexy/complications , Pituitary Gland/pathology , Pituitary Neoplasms/complications , Tomography, X-Ray ComputedABSTRACT
Two endocrine active pituitary microadenomas were treated by transsphenoidal microsurgery and evaluated endocrinologically by radioimmunoassay of hormones. They showed significant rise of serum human growth hormone(HGH) after thyrotrophine releasing hormone(TRH) administration and no suppression by oral glucose tolerance test(GTT) before operation. Pathologic findings are acidophilic adenomas.