Multihormonal response to CRH in a patient with Cushing syndrome and a pituitary adenoma producing ACTH and GH

Abstract

Preoperative bilateral and simultaneous catheterization of the inferior petrosal sinuses was performed in a patient with Cushing's syndrome. This procedure revealed parallel intersinus gradients for ACTH, PRL, GH and a response of all these hormones to CRH. The patient had transphenoidal surgery and a soft white-yellowish mass occupying the whole sella conditioned a total hypophysectomy. Morphologic studies and immunostaining techniques revealed a rare mixed pituitary adenoma of ACTH and GH containing cells and failed to demonstrate PRL immunoreactivity in the tumor cells. These results are of clinical and speculative interest. Whether GH and PRL secretion in response to CRH stems from the tumor or reflect hormone release by non-tumor cells via a paracrine effect remains to be defined.

A Case of pituitary somatotroph adenoma with concomitant secretion of growth hormone, prolactin, and adrenocorticotropic hormone ? an adenoma derived from primordial stem cell, studied by immunohistochemistry, in situ hybridization, and cell culture

“…However, somatotroph adenomas showing hypersecretion of ACTH are extremely rare. There have been, to our knowledge, only five published reports of somatotroph adenomas accompanied by excessive ACTH secretion [2,5,8,21,24]. We also experienced a case of somatotroph adenoma with high serum GH, PRL, and ACTH levels.…”

Growth hormone and prolactin responses to corticotrophin‐releasing‐hormone in patients with Cushing's disease: a paracrine action of the adenomatous corticotrophic cells?

“…Moreover, it is unlikely that underestimation by immunohistochemical techniques might involve 18 of 22 tumours reported in the present study, that theoretically could have had a variable proportion of GH or PRL secreting cells within the adenoma. Indeed, it has been reported that oCRH can elicit in vitro increases in hormones other than ACTH in mixed ACTH and PRL and in mixed ACTH and GH secreting adenomas (Yamaji et al, 1985;Bughalho et al, 1993). In both cases the mechanism underlying this finding was unexplained.…”

“…Indeed, it has been reported that oCRH can elicit in vitro increases in hormones other than ACTH in mixed ACTH and PRL and in mixed ACTH and GH secreting adenomas (Yamaji et al, 1985;Bughalho et al, 1993). Indeed, it has been reported that oCRH can elicit in vitro increases in hormones other than ACTH in mixed ACTH and PRL and in mixed ACTH and GH secreting adenomas (Yamaji et al, 1985;Bughalho et al, 1993).…”