DOUBLE PITUITARY ADENOMAS WITH DISTINCT HISTOLOGICAL FEATURES: PRESENTATION OF AN INTERESTING CASE. (February 2015)

• Record Type: Journal Article
• Authors: Ghahan, Raha Madadi; De Sousa, Sunita; Earls, Peter
• Is Part Of: Pathology. Volume 47(2015)Supplement 1
• Publication Date: 2015-02
• Subjects: Pathology -- Periodicals; 616.0705
• DOI: 10.1097/01.PAT.0000461510.03139.da
• Languages: English
• ISSNs: 0031-3025

Abstract

Abstract : Introduction: Double pituitary adenomas are rare. The incidence is approximately 1% of autopsy pituitaries and 0.4–2.6% of large surgical series. The growth hormone producing pituitary adenomas are classified as densely granulated type and sparsely granulated type. The latter shows a more aggressive clinical course. Case presentation: A 27-year-old Bangladeshi male presented with acromegaly and a high serum IGF-1 (189 nmol/L with a normal range of 15–50 nmol/L). MRI showed a 9 mm hypo-enhancing nodule in his right pituitary consistent with a micro adenoma. During trans-sphenoidal surgery, no macroscopic lesion was found in the right side, however a well demarcated nodule was seen in the left pituitary (not identified on the imaging). This was resected and histologically confirmed as a growth hormone-producing adenoma of sparsely granulated type. Three monthly screening revealed a sustained high serum IGF-1 (142 nmol/L) leading to further investigation and a second operation to resect an encapsulated nodule in the right pituitary with no connection to the left. This lesion was proven to be another growth hormone-producing adenoma of densely granulated type. Discussion: Double pituitary adenomas are rare. The distinction between different subtypes of growth hormone producing adenomas can impact on medical therapy and patients' outcomes.