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A case of non‐functioning pituitary adenoma with Cushing's syndrome upon recurrence
Author(s) -
Yokoyama Shunichi,
Kawahara Yoshihiro,
Sano Toshiaki,
Nakayama Masaki,
Kitajima Shinichi,
Kuratsu Junichi
Publication year - 2001
Publication title -
neuropathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.701
H-Index - 61
eISSN - 1440-1789
pISSN - 0919-6544
DOI - 10.1046/j.1440-1789.2001.00409.x
Subject(s) - cushing's disease , pituitary adenoma , corticotropic cell , adenoma , adrenocorticotropic hormone , medicine , pathology , transsphenoidal surgery , acromegaly , pituitary gland , hormone , disease , growth hormone
A 49‐year‐old woman presented with left visual disturbance. No signs of Cushing's disease were evident. Basal levels of serum cortisol and plasma adrenocorticotropic hormone (ACTH) were 16.8 μg/dL and 66.0 pg/mL, respectively. MRI demonstrated an irregularly shaped large pituitary tumor, and the patient then underwent transsphenoidal surgery. By light microscopy the tumor represented a chromophobic adenoma with a few of the adenoma cells showing immunoreactivity for ACTH. On the basis of clinical and light microscopic examinations, the diagnosis of silent corticotroph adenoma was made. Electron microscopy, however, demonstrated the honeycomb Golgi complex that has been reported as a typical finding of gonadotroph adenomas. MRI taken 7 months after the first operation revealed adenoma regrowth. Transcranial surgery was performed, and histology demonstrated a chromophobic pituitary adenoma with most cells immunopositive for ACTH. She was treated with gamma knife postoperatively. Three months later, MRI revealed remarkable shrinkage of the adenoma, but she developed typical signs and symptoms of Cushing's disease. Thus, the hormone immunostaining and biological activity of pituitary adenomas may change with time.