Acromegaly with Hyperprolactinemia Developed after Bilateral Adrenalectomy in a Patient with Cushing's Syndrome due to Adrenocortical Nodular Hyperplasia.

Abstract

Abstract. A 27-yr-old woman was referred for evaluation of acromegaly and hyperprolactinemia. She had undergone left adrenalectomy at 12 and right adrenalectomy at 17 for Cushing's syndrome due to adrenocortical nodular hyperplasia. At this time a pituitary tumor was found by brain computerized tomography, but plasma levels of growth hormone (GH), prolactin (PRL) and adrenocorticotropin (ACTH) were normal. When she was 23, symptoms and signs of acromegaly and subsequently galactorrhea-amenorrhea had developed. Plasma GH and PRL were increased and she was followed up by the administration of bromocriptine (2.5 mg-12.5 mg/day, p.o.). However the plasma GH level had been increasing gradually. On admission, plasma GH and PRL were high (19.5 µg/L, 61.0 µg/L, respectively) and increased in response to thyrotropin releasing hormone (TRH, 500 µg iv). An intrasella mass, which had been detected when she was 17, had become enlarged and was removed by Hardy's operation. Microscopically, the resected tumor was an eosinophilic adenoma. Immunohistochemical studies showed GH, PRL and ACTH positive cells localized in the tumor. Immunoultrastructural analysis of the tumor confirmed that GH, PRL and ACTH were present in secretory granules and Golgi apparatus in the tumor cells. The patient was a rare case of acromegaly with hyperprolactinemia developed after bilateral adrenalectomy of fishing's syndrome due to adrenocortical nodular hyperplasia, all of which manifestations may be caused by a GH, PRL and ACTH secreting pituitary adenoma.

A Decrease in the Dose of Pegvisomant was Needed for the Treatment of Acromegaly after Adrenalectomy in a Patient with Coexisting Preclinical Cushing's Syndrome

“…Previously reported cases suffering from both of these endocrinopathies included patients with an ectopic ACTH-and GH-producing tumor (4, 5), pituitary tumors secreting both human GH and ACTH (6, 7), or pituitary tumors secreting GH and ACTH-independent adrenal hypersecretion (8)(9)(10). In the present report, we describe a rare case of pre-clinical Cushing's syndrome caused by an adrenal adenoma discovered a few years after transsphenoidal selective removal of a pituitary adenoma for acromegaly.…”

Pituitary Pathology in Carney Complex Patients

“…In CNC this course is even slower and acromegaly is often unmasked by adrenalectomy for primary pigmented nodular adrenocortical disease (PPNAD) [27]. In our prospective evaluation of patients with CNC, we have had the opportunity to observe the "development" of pituitary adenomas, so far in 4 patients.…”

Physiological Roles of Prolactin in the Adrenocortical Response to Acute Restraint Stress

“…In contrast, hypoprolactinemia seems to inhibit the hypothalamohyophyseal-adrenal axis. It had been shown that bro-mocriptine suppresses the plasma ACTH concentration in patients with Cushing disease and Nelson's syndrome [16][17][18]. Additionally, treatment with bromocriptin for 6 days significantly reduced both PRL and cortisol concentrations in castrated pigs [19].…”