Plurihormonal and Plurifunctional Pituitary Adenoma with Acromegaly

Overview

Woman 75-year-old treated 30 years for syndrome of acromegaly refused pituitary surgery and irradiation. Fiveyears and nine months before death she had a colon carcinoma successfully removed. Multinodular hyperfunctionalgoitre was treated with carbimazole. For six last years of life corticosteroids were given as a replacement therapy.Her cause of death was the heart failure due to acromegalic heart disease. In autopsy a large intrasellar and extrasellarpituitary adenoma without rests of nonneoplastic tissue was found. Nevertheless the target peripheral endocrineglands except ovaries, were not atrophic. A multinodular goitre and diffuse adrenocortical hyperplasia were revealed.Histology, and immunohistochemistry demonstrated that mot neoplastic cells were producing GH and ACTH,dispersly Prl, scattered cells were positive for b-subunit of FSH, LH, TSH. Electron microscopy proved most of thecells to be densely granulated. We classify the adenoma according to the newly proposed WHO pituitary tumoursclassification (1) as plurihormonal, hyperfunctional, extrasellar, typical adenoma from densely granulated cells. Weconclude that in plurihormonal adenomas with dominant (in the case referred acromegalic) symptomatology theadditional hormonal production should be monitored as a possible source of important complications.

Key words:
pituitary, acromegaly, plurihormonal adenoma.