A composite somatotroph-corticotroph pituitary adenoma |
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Authors: | Robyn L Apel Robert J Wilson Sylvia L Asa |
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Institution: | 1. Department of Pathology, Mount Sinai Hospital and University of Toronto, 600 University Avenue, M5G 1X5, Toronto, Ontario, Canada 2. Department of Medicine, Hotel Dieu of St. Joseph Hospital, Windsor, Ontario, Canada
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Abstract: | A 76-year-old woman presented with enlargement and weakness of her hands and feet coarsening of facial features, proximal
muscle weakness, and worsening of her noninsulindependent diabetes mellitus. Serum growth hormone, somatomedin-C, and prolactin
levels were elevated. Thyroid function test results and serum cortisol and adrenocorticotropic hormone levels were within
normal limits. Luteinizing and follicle-stimulating hormone levels were both low, suggesting possible partial hypopituitarism.
Magnetic resonance imaging of the sella demonstrated a pituitary lesion that measured 2.2 x 1 x 0.5 cm; it partially obliterated
the suprasellar cistern and it distorted the optic chiasm. Light microscopic and ultrastructural examination of the trans-sphenoidally
resected tissues identified characteristic features of 2 discrete pituitary adenomas that were in close apposition, but they
were sharply demarcated. The 2 components were a corticotroph adenoma and a sparsely granulated somatotroph adenoma. Multiple
adenomas of the pituitary are not rare; however, the majority are endocrinologically “nonfunctional.” We report a patient
with clinical features of acromegaly whose tumor was a composite lesion: one area exhibited morphological characteristics
of a corticotroph adenoma and another distinct area exhibited features of a somatotroph adenoma. The possible histogenesis
is discussed. |
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Keywords: | |
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