Synchronous GH- and prolactin-secreting pituitary adenomas

Abstract

SummaryPituitary adenomas are usually solitary lesions. Rarely, patients may present with two distinct pituitary tumors. We report a case of synchronous secretory pituitary adenomas in a woman who initially presented with elevated prolactin levels. She was initially treated with cabergoline, but, after many years, she began developing symptoms consistent with acromegaly. Imaging revealed two distinct tumors within the pituitary gland. Endocrinological investigation confirmed acromegaly. At the time of surgery, two separate tumors were identified and resected. Pathological analysis demonstrated one tumor as a prolactinoma, and the other tumor as a GH-secreting adenoma. Postoperatively, her GH and IGF1 levels normalized, while the prolactin level remained slightly above normal. This case highlights that GH and prolactin level elevation is not always from co-secretion by the same adenoma.Learning points Synchronous pituitary adenomas represent <0.5% of pituitary tumors requiring surgery.In the setting of elevated GH and prolactin levels, one cannot assume that they are co-secreted by the same adenoma.A careful study of hormonal workup and pre-operative imaging is necessary for synchronous pituitary adenomas to assure resection of both tumors.

Multiple Pituitary Adenomas: A Systematic Review

“…Of 63 fully documented clinical cases reported until now, 24 presented as Cushing’s syndrome ( 5 , 29 , 30 , 56 , 36 , 41 , 42 , 54 – 58 ), closely followed by acromegaly with 22 cases ( 5 , 9 , 32 , 33 , 39 , 41 , 50 , 53 , 54 , 58 – 63 ). Of note, synchronous ACTH- and GH-producing tumors were confirmed by IHC in seven patients; three of these cases expressed clinically as Cushing’s syndrome, one as acromegaly, and three were diagnosed with both hyperadrenalism and acromegaly ( 54 , 58 , 59 ) (Table 3 ).…”

Successful debulking of plurihormonal pituitary macroadenoma with long‐acting pasireotide and dopamine agonist combination therapy

“…Here, we present a complicated case of a pituitary macroadenoma secreting prolactin and GH from 2 cell lines. Approximately 25% of GH-secreting adenomas co-secrete prolactin, 15 and co-secretion of GH in prolactinomas has been documented at the time of initial diagnosis and years afterward. 16 MRI ( Figure 2D) and observation during this patient's surgery did not reveal separate tumors, and the bulk of the tumor resected was secreting prolactin with sporadic cells secreting GH.…”