Endocrine Journal
Online ISSN : 1348-4540
Print ISSN : 0918-8959
ISSN-L : 0918-8959
Acromegaly with Hyperprolactinemia Developed after Bilateral Adrenalectomy in a Patient with Gushing's Syndrome due to Adrenocortical Nodular Hyperplasia
ATSUSHI OGOMASAFUMI HAJISHOICHI NATORITAKESHI KANZAKIYASUHIRO KABAYAMAR. YOSHIYUKI OSAMURAHAJIME NAWATAHIROSHI IBAYASHI
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1993 Volume 40 Issue 1 Pages 17-25

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Abstract

A 27-yr-old woman was referred for evaluation of acromegaly and hyperprolactinemia. She had undergone left adrenalectomy at 12 and right adrenalectomy at 17 for Cushing's syndrome due to adrenocortical nodular hyperplasia. At this time a pituitary tumor was found by brain computerized tomography, but plasma levels of growth hormone (GH), prolactin (PRL) and adrenocorticotropin (ACTH) were normal. When she was 23, symptoms and signs of acromegaly and subsequently galactorrhea-amenorrhea had developed. Plasma GH and PRL were increased and she was followed up by the administration of bromocriptine (2.5mg-12.5mg/day, p.o.). However the plasma GH level had been increasing gradually. On admission, plasma GH and PRL were high (19.5μg/L, 61.0μg/L, respectively) and increased in response to thyrotropin releasing hormone (TRH, 500μg iv). An intrasella mass, which had been detected when she was 17, had become enlarged and was removed by Hardy's operation. Microscopically, the resected tumor was an eosinophilic adenoma. Immunohistochemical studies showed GH, PRL and ACTH positive cells localized in the tumor. Immunoultrastructural analysis of the tumor confirmed that GH, PRL and ACTH were present in secretory granules and Golgi apparatus in the tumor cells. The patient was a rare case of acromegaly with hyperprolactinemia developed after bilateral adrenalectomy of fishing's syndrome due to adrenocortical nodular hyperplasia, all of which manifestations may be caused by a GH, PRL and ACTH secreting pituitary adenoma.

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© The Japan Endocrine Society
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