Endocrinol Metab.  2015 Sep;30(3):389-394. 10.3803/EnM.2015.30.3.389.

Acromegaly due to a Macroinvasive Plurihormonal Pituitary Adenoma and a Rectal Carcinoid Tumor

• Chin SO
• Hwang JK
• Rhee SY
• Chon S
• Oh S
• Lee M
• Pellegata
• Kim SW

• KMID: 2407091
• DOI: http://doi.org/10.3803/EnM.2015.30.3.389

Abstract

A macroinvasive pituitary adenoma with plurihormonality usually causes acromegaly and hyperprolactinemia, and also accompanies with neurologic symptoms such as visual disturbances. However, its concurrent presentation with a rectal carcinoid tumor is rarely observed. This study reports the history, biochemical, colonoscopic and immunohistochemical results of a 48-year-old female with acromegaly and hyperprolactinemia. Despite the large size and invasive nature of the pituitary adenoma to adjacent anatomical structures, she did not complain of any neurologic symptoms such as visual disturbance or headache. Immunohistochemical staining of the surgical specimen from the pituitary adenoma revealed that the tumor cells were positive for growth hormone (GH), prolactin (PRL), and thyroid stimulating hormone (TSH). Staining for pituitary-specific transcription factor-1 (Pit-1) was shown to be strongly positive, which could have been possibly contributing to the plurihormonality of this adenoma. Colonoscopy found a rectal polyp that was identified to be a carcinoid tumor using immunohistochemical staining. A macroinvasive pituitary adenoma with concomitant rectal carcinoid tumor was secreting GH, PRL, and TSH, which were believed to be in association with over-expression of Pit-1. This is the first case report of double primary tumors comprising a plurihormonal pituitary macroadenoma and rectal carcinoid tumor.

Keyword

Acromegaly; Plurihormonality; Pit-1

MeSH Terms

Acromegaly*
Adenoma
Carcinoid Tumor*
Colonoscopy
Female
Growth Hormone
Headache
Humans
Hyperprolactinemia
Middle Aged
Neurologic Manifestations
Pituitary Neoplasms*
Polyps
Prolactin
Thyrotropin
Growth Hormone
Prolactin
Thyrotropin

Figure

• 

  Fig. 1 The pathologic findings of a specimen from the pituitary adenoma: (A) growth hormone, (B) prolactin, (C) thyroid stimulating hormone staining were positive, while (D) adrenocorticotropic hormone, (E) follicle-stimulating hormone, and (F) luteinizing hormone staining were negative (×200).

• 

  Fig. 2 Expression of lineage-specific transcription factor (pituitary-specific transcription factor-1 [Pit-1]) found in the pituitary adenoma; immunohistochemistry (IHC) was performed using an antibody against Pit-1. Counterstaining with hematoxylin. IHC staining was positive for Pit-1 (×400).

• 

  Fig. 3 The pathologic findings of a specimen from the rectal carcinoid tumor: (A) H&E staining of the carcinoid tumor, (B) CD56, and (C) synaptophysin staining were positive, but (D) chromogranin staining was negative (×200).

• 

  Fig. 4 T1-weighted magnetic resonance images enhanced with gadolinium: (A) axial view, (B) sagittal view, and (C) coronal view; each image is composed of annual follow-up images. The initial diameter of the tumor was about 7.5 cm; it invaded into the supra-, infra- and parasella areas and the cavernous sinus and extended to the level of the brain stem and compressed the optic chiasm. The carotid artery was encased by the mass. After transsphenoidal adenectomy with adjuvant octreotide treatment, the tumor size gradually decreased.

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