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A somatotropin-producing pituitary adenoma with an isolated adrenocorticotropin-producing pituitary adenoma in a female patient with acromegaly, subclinical Cushing's disease and a left adrenal tumor.
[adrenal incidentaloma]
A
67
-
year
-old
female
with
hypertension
and
impaired
glucose
tolerance
was
admitted
to
our
hospital
because
of
a
typical
acromegalic
appearance
,
including
large
,
thickened
bulky
hands
and
feet
,
and
a
large
prominent
forehead
and
tongue
.
She
did
not
have
a
Cushingoid
appearance
,
such
as
a
moon-face
,
buffalo
hump
,
purple
striae
or
central
obesity
.
The
laboratory
data
revealed
a
serum
GH
level
of
4
.
6
ng
/
mL
and
serum
insulin
-like
growth
factor
-
1
level
of
811
ng
/
mL
.
The
oral
glucose
tolerance
test
showed
no
suppression
of
the
GH
values
.
An
endocrine
examination
showed
a
lack
of
circadian
rhythmicity
of
ACTH
and
cortisol
.
Cortisol
was
not
suppressed
by
a
low
dose
of
dexamethasone
during
the
suppression
test
,
but
was
suppressed
by
a
high
dose
of
dexamethasone
.
A
radiological
study
revealed
two
isolated
adenomas
in
the
pituitary
and
a
left
adrenal
tumor
.
These
findings
strongly
suggested
a
diagnosis
of
acromegaly
with
subclinical
Cushing
's
disease
and
a
left
adrenal
incidentaloma
.
Transsphenoidal
surgery
was
performed
.
Hematoxylin
and
eosin
staining
showed
that
the
left
and
right
pituitary
adenomas
were
composed
of
basophilic
and
acidophilic
cells
,
respectively
.
Immunohistochemical
staining
showed
the
left
adenoma
to
be
positive
for
ACTH
and
negative
for
GH
.
In
contrast
,
the
right
adenoma
was
GH-
positive
and
ACTH-negative
.
This
is
a
rare
case
of
independent
double
pituitary
adenomas
with
distinct
hormonal
features
.
We
also
provide
a
review
of
the
previously
reported
cases
of
double
pituitary
adenomas
and
discuss
the
etiology
of
these
tumors
.
