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Case Reports: Rare disease
Plurihormonal pituitary adenoma cosecreting ACTH and GH: a rare cause of Cushing’s disease
  1. Jumana Amir1,
  2. Marie Christine Guiot2 and
  3. Natasha Garfield1
  1. 1Endocrinology, McGill University Health Centre, Montreal, Canada
  2. 2Neuropathology, McGill University Health Centre, Montreal, Canada
  1. Correspondence to Dr Jumana Amir; jumana.amir{at}mail.mcgill.ca

Abstract

Plurihormonal pituitary adenomas are rare forms of pituitary adenomas that express more than one hormone. The most common association is with growth hormone (GH) and prolactin. Cosecretion of GH and adrenocorticotrophic hormone (ACTH) is rare with only 25 reported cases in literature. Most presented with features of GH excess, and only four presented with Cushing’s disease. We report a case of a woman in her 30s with recurrent plurihormonal pituitary macroadenoma cosecreting GH and ACTH, diagnosed during workup for polycystic ovarian syndrome, and both times presenting uniquely with Cushing’s disease. Biochemical testing showed GH excess and hypercortisolism. She underwent transsphenoidal surgery twice and immunohistochemistry showed positive staining for GH and ACTH on both occasions. We aim to raise more awareness of this rare type of pituitary adenoma, shed light on the importance of recognising rare presentations and highlight the necessity of rigorous follow-up given morbidity and potentially higher mortality risk.

  • Pituitary disorders
  • Neuroendocrinology
  • Endocrinology

https://doi.org/10.1136/bcr-2022-251451

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    Footnotes

    • Contributors JA and NG formulated the concept of the case report, and obtained the data. All authors were involved in carrying out the investigations (MCG conducted pathology investigations, JA and NG conducted the biochemical and radiological investigations). JA and NG were involved in management and follow up. JA wrote the manuscript draft. All authors reviewed and edited and approved the final manuscript. All authors had complete access to case material.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.