OBJECTIVETo discuss the clinical pathology and management of mixed growth hormone- and prolactin (GH-PRL) cell adenoma.

METHODEight patients (4 men and 4 women, with the mean age of 32.3 year old and duration of symptoms 12 months) underwent examination of serum endocrine and magnetic resonance imaging. Clinical manifestations included headache, physiognomy of acromegalic patient, large pudgy hands and foots, menstrual dysfunction, amenorrhea, galactorrhea, and descending vision. Patients underwent transsphenoidal microsurgery of mixed GH-PRL pituitary adenoma between 1986 and 2004.

RESULTSThe hypersecretion of GH and PRL was relieved after operation. Headache was obviously improved in all patients. In 5 cases the menstrual dysfunction and amenorrhea were recovered. In 4 cases the galactorrhea and descending vision disappeared.

CONCLUSIONSThe diagnosis of mixed GH-PRL pituitary adenoma can be made according to the results examination of serum endocrine, pathology and clinical manifestations. Its endocrine features are related to the invasion extent of the adenoma. The transsphenoidal approach is the preferred treatment for mixed GH-PRL pituitary adenoma.

Adenoma ; diagnosis ; pathology ; secretion ; Adolescent ; Adult ; Female ; Growth Hormone ; secretion ; Humans ; Male ; Pituitary Neoplasms ; diagnosis ; pathology ; secretion ; Prolactin ; secretion ; Prolactinoma ; diagnosis ; pathology ; secretion

We present a 45-yr-old male with clinical signs and symptoms of mild hyperthyroidism, high serum levels of T3, T4, and FT4 as well as serum TSH concentration. The elevated alpha-subunit level and alpha-subunit/TSH molar ratio were also observed. These findings indicated the presence of hyperthyroidism due to inappropriate secretion of TSH, whose neoplastic origin was documented by nuclear magnetic resonance scan showing a 0. 6 cm pituitary adenoma. Selective pituitary adenomectomy was completely successful; alpha-subunit, TSH, T3, T 4, and FT4 normalized, and euthyroidism was restored. Light microscopic immunohistochemistry showed that the adenoma was composed of TSH-secreting cells
Adenoma/diagnosis/pathology/*secretion ; Case Report ; Human ; Magnetic Resonance Imaging ; Male ; Middle Age ; Pituitary Neoplasms/diagnosis/pathology/*secretion ; Thyrotropin/*secretion

Choledochal cyst is an uncommon premalignant anomaly. The morphology and pathogenesis of the premalignant lesion of cholangiocarcinoma arising from the choledochal cyst has not been well described. Herein, we report a rare case of bile duct adenoma arising from choledochal cyst with anomalous union of pancreaticobiliary duct (AUPBD). 50-year-old woman was admitted to our hospital with the complaint of epigastric pain. She had received common bile duct (CBD) exploration and choledocholithotomy and cholecystectomy 3 months earlier under the diagnosis of multiple CBD stones. Intraoperalive cholangiogram was not remarkable except CBD dilatation at that time. Endoscopic retrograde cholangiopancreatography revealed choledochal cyst with AUPBD and round filling defect which disappeared easily on the balloon cholaniogram. On magnetic resonance cholangiopancreatography, the filling defect was confirmed as 2 cm polypoid mass attached to the distal bile duct wall. At laparotomy, a soft whitish mass was palpable on the lower CBD. On histological examination, adenoma with focal carcinoma change arising from choledochal cyst was diagnosed.
Adenoma, Villous/*diagnosis/pathology/radiography ; Bile Duct Neoplasms/*diagnosis/pathology/radiography ; Cholangiopancreatography, Magnetic Resonance ; Choledochal Cyst/*radiography/secretion/surgery ; Female ; Humans ; Middle Aged ; Tomography, X-Ray Computed

Adenocarcinoma, Mucinous ; pathology ; Adenoma ; pathology ; Adolescent ; Breast Neoplasms, Male ; metabolism ; pathology ; secretion ; surgery ; Carcinoma ; metabolism ; pathology ; secretion ; surgery ; Diagnosis, Differential ; Humans ; Keratin-18 ; metabolism ; Keratin-8 ; metabolism ; Male ; Mastectomy, Modified Radical ; Proto-Oncogene Proteins c-kit ; metabolism ; S100 Proteins ; metabolism

The aim of this study was to investigate the relationship between somatostatinergic tone (SST) and the size of growth hormone (GH)-producing pituitary tumors. GH levels of 29 patients with newly diagnosed acromegaly were measured using a 75-gram oral glucose tolerance test (OGTT), an insulin tolerance test (ITT), and an octreotide suppression test (OST). Differences between GH levels during the ITT and the OGTT (DeltaGH(IO)), and between the OGTT and the OST at the same time point (DeltaGH(OS)) were compared according to the size of the tumor and the response pattern to the OST. DeltaGH(IO) of macroadenomas (n=22) was non-significantly higher than those of microadenomas while DeltaGH(OS) of macroadenomas were significantly higher than those of microadenomas. According to further analyses of macroadenomas based on the response pattern to the OST, GH levels during the ITT were significantly higher in non-responders. DeltaGH(OS) showed near-significant differences between responders and non-responders. In conclusion, as the size of the pituitary tumor increases, the effect of glucose on SST appears to be attenuated. Macroadenomas that are non-responders to the OST possess a portion of GH secretion exceeding the range of regulation by SST.
Acromegaly/*diagnosis/*pathology ; Adenoma/drug therapy/*pathology ; Adult ; Aged ; Antineoplastic Agents, Hormonal/therapeutic use ; Female ; Glucose Tolerance Test ; Human Growth Hormone/*blood/secretion ; Humans ; Insulin/blood ; Insulin-Like Growth Factor I/analysis ; Male ; Middle Aged ; Octreotide/therapeutic use ; Pituitary Neoplasms/drug therapy/*pathology