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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
.
Diseases
Validation
Diseases presenting
"hypertension"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
aniridia
aromatase deficiency
cadasil
child syndrome
cohen syndrome
congenital adrenal hyperplasia
congenital diaphragmatic hernia
cushing syndrome
cystinuria
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
fabry disease
familial hypocalciuric hypercalcemia
gm1 gangliosidosis
heparin-induced thrombocytopenia
hereditary cerebral hemorrhage with amyloidosis
holt-oram syndrome
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
inclusion body myositis
kallmann syndrome
kindler syndrome
lamellar ichthyosis
lymphangioleiomyomatosis
pendred syndrome
primary effusion lymphoma
scrub typhus
severe combined immunodeficiency
sneddon syndrome
typhoid
von hippel-lindau disease
well-differentiated liposarcoma
werner syndrome
x-linked adrenoleukodystrophy
zellweger syndrome
This symptom has already been validated
