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

A 39-yr-old woman, who had been treated for Behcet's disease for 4 yr, was admitted for further investigation of recently identified hypokalemia and hypertension. Suppressed plasma renin activity with elevated plasma aldosterone concentration and an anomalous postural decrease in plasma aldosterone were observed. An abdominal CT scan revealed a right adrenal mass. The patient was diagnosed with Conn's syndrome. The association of Conn's syndrome with Behcet's disease was thought to be coincidental. To our knowledge, this is the first case of Conn's syndrome associated with Behcet's disease.
Adenoma/complications ; Adenoma/radiography ; Adenoma/secretion ; Adenoma/surgery ; Adrenal Cortex Neoplasms/complications ; Adrenal Cortex Neoplasms/radiography ; Adrenal Cortex Neoplasms/secretion ; Adrenal Cortex Neoplasms/surgery ; Adrenalectomy ; Adult ; Aldosterone/secretion ; Behcet Syndrome/complications* ; Female ; Human ; Hyperaldosteronism/blood ; Hyperaldosteronism/complications*

OBJECTIVETo study the clinicopathological features of thyrotropin-secreting pituitary adenoma (TSH adenoma).

METHODSClinical and pathological features of 7 TSH adenoma cases were studied by review of patients' medical records, light and electronic microscopy, and immunohistochemistry.

RESULTSAll seven patients presented with clinical hyperthyroidism and high levels of plasma free T3, free T4, total T3 and total T4. The levels of TSH failed to be suppressed by thyroxin administration. MRI showed macro or giant pituitary adenomas in all seven patients with tumor diameters ranging from 2.0 to 5.0 cm. Under light microscope, there were 5 cases of chromophobe cell adenoma, 1 case of acidophil cell adenoma, and 1 case of mixed acidophil and chromophobe cell adenoma. Immunohistochemical stains showed a strong positivity of TSH in all the tumors, PRL positive cells in 1 tumor, GH positive cells in 2 tumors and scattered GH and PRL double positive cells in 3 tumors. Ki-67 proliferation index ranged from 0 approximately 0.4%. P53 immunostain was negative in all tumors. After initial surgery, 2 cases had recurrences. However, the Ki-67 proliferation index was not elevated in these two tumors.

CONCLUSIONSThe histological features of TSH pituitary adenomas are heterogeneous with chromophobe as the most common subtype. Secretion of TSH was detected by immunohistochemistry in all cases. P53 mutation is not a feature of TSH adenoma and the proliferation marker, such as Ki-67, may not predict clinical behavior of the tumor. Recurrence is likely due to incomplete resection.

Adenoma ; pathology ; secretion ; Adult ; Aged ; Female ; Humans ; Hyperthyroidism ; blood ; etiology ; Ki-67 Antigen ; blood ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pituitary Neoplasms ; pathology ; secretion ; Thyrotropin ; secretion

OBJECTIVETo evaluate magnetic resonance imaging (MRI) characteristics and surgical results of adrenocorticotropin (ACTH)-secreting pituitary adenomas.

METHODSMRI characteristics and relationship between MRI positive rate and surgical results of 266 patients with pathologically confirmed Cushing's disease were analyzed retrospectively. All patients underwent thin-section sagittal and coronal scans of the pituitary gland before and after administration of gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) on a 1.5 Tesla MRI scanner, and dynamic enhanced MRI was performed in 39 patients. All patients underwent transsphenoidal adenomectomy. Endocrinological examinations and assessments were performed.

RESULTSPreoperative MRI revealed normal results in 41 (15.4%) cases, microadenoma in 179 (67.3%), macroadenoma in 42 (15.8%), and huge adenoma in 4 (1.5%). Pituitary apoplexy was found in 13 (4.9%) cases. Positive rate of ACTH-secreting adenomas was 84.6% (225/266) on MRI scans, and that of small microadenomas was 87.2% (34/39) on dynamic enhanced MRI scans. Preoperative endocrinological tests of 199 cases supported the diagnosis of typical Cushing's disease, while the other 67 cases had atypical endocrinological results. The endocrinological cure rate, remission rate, and inefficacy rate were 85.7%, 7.9%, and 6.4%, respectively. There was no difference in the initial endocrinological cure rate between the patients with positive and normal MRI results (90% vs. 87.8%, P = 0.904).

CONCLUSIONSEnhanced coronal pituitary MRI is helpful for preoperative localization of ACTH-secreting pituitary microadenoma. Dynamic enhanced MRI may improve detection rate of microadenoma. There is no marked difference in the surgical results for patients with preoperative MRI results indicating presence or absence of microadenoma.

Adenoma ; diagnosis ; secretion ; surgery ; Adolescent ; Adrenocorticotropic Hormone ; secretion ; Adult ; Child ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Pituitary Neoplasms ; diagnosis ; secretion ; surgery

In order to elucidate the effect of acetylcholine (ACh) on the occurrence and development of human pituitary adenoma, it was firstly observed whether there exists choline acetyl transferase (ChAT) which is necessary for the synthesis of acetylcholine in the cells of human pituitary adenoma, and then MTT method, (3)H TdR incorporation, cell cycle analysis and TUNEL were employed to estimate the influence of ACh on the proliferation, DNA synthesis and apoptosis of three kinds of human pituitary adenoma (human prolactinoma, somatotropinoma and non-functional tumor) cells cultured in vitro. The results showed that (1) the positive staining of ChAT was obviously observed in the cells of the three kinds of human pituitary adenoma, however, it was lower than that in normal human pituitary gland; (2) ACh had a similar effect on the proliferation of the three kinds of human pituitary adenoma cells. ACh at 0.1-10 micromol/L decreased the (3)H TdR incorporation and the MTT A value in a dose-dependent manner. At the same time, ACh decreased the ratio of S or G(2) phase pituitary adenoma cells significantly, but increased the ratio of G(1) phase pituitary tumour cells markedly; (3) the effect of acetylcholine on the proliferation of human pituitary adenoma cells was inhibited by atropine, but not by tubocurarine; (4) ACh had no effect on the apoptosis of human pituitary adenoma cells cultured in vitro. These data suggest that ACh may have a significant modulating effect on the proliferation of pituitary adenoma cells by means of paracrine or autocrine, and the effect is mediated by muscarinic receptor.
Acetylcholine ; pharmacology ; physiology ; Acetyltransferases ; biosynthesis ; physiology ; Adenoma ; pathology ; secretion ; Apoptosis ; drug effects ; Cell Division ; drug effects ; Dose-Response Relationship, Drug ; Humans ; Pituitary Neoplasms ; pathology ; secretion ; Tumor Cells, Cultured

It has been suggested that the patients with Cushing's disease secondary to pituitary macroadenomas (>10 mm) have higher basal adrenocorticotropic hormone (ACTH) levels, which are less suppressible on high-dose dexamethasone suppression tests (HDDST). We compared the clinical and biochemical characteristics of patients with macroadenomas (N=7) and microadenomas (N=23) who were diagnosed at Samsung Medical Center in Korea between 1996 and 2006. Basal morning plasma ACTH levels were 101.5+/-23.2 pg/mL for macroadenoma patients and 83.6+/-11.1 pg/mL for microadenoma patients (mean+/-SEMs) (p=0.44). Morning serum cortisol levels were 26.8+/-3.2 microgram/dL for macroadenoma patients and 29.5 +/-2.9 microgram/dL for microadenoma patients (p=0.77). The proportion of patients who showed suppressibility on HDDST was almost identical in the two groups (71.4% [5/7] for macroadenoma patients vs. 72.7% [16/22] for microadenoma patients, p=1.00). Furthermore, the remission rate with trans-sphenoidal surgery was similar between the two groups (100% [5/5] for macroadenoma patients vs. 73.3% [11/ 15] for microadenoma patients, p=0.53). Thus, tumor size is not a major determinant of hormone secretion or clinical outcomes in patients with Cushing's disease.
Adenoma/complications/*metabolism/surgery ; Adolescent ; Adrenocorticotropic Hormone/blood/*secretion ; Adult ; Aged ; Dexamethasone/metabolism ; Female ; Humans ; Hydrocortisone/blood/*secretion ; Male ; Middle Aged ; Pituitary ACTH Hypersecretion/*diagnosis/etiology ; Pituitary Neoplasms/complications/*metabolism/surgery ; Retrospective Studies

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

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

In order to investigate the effect of leptin on the secretion of rat pituitary adenoma GH3 cell and its mechanisms, we observed the effect of leptin on the growth hormone secretion, proliferation and apoptosis of GH3 cells. The results indicated that leptin at 1, 10, and 100 nmol/L could inhibit the basal growth hormone secretion of GH3 cells in a dose dependent manner (P<0.05). Short-term treatment of leptin (10 nmol/L) for 30 min, 1 and 3 h did not affect basal GH secretion. However, treatment of the GH3 cells with leptin (10 nmol/L) for 1 d or longer resulted in an inhibition of GH secretion (P<0.05). We used MTT method and flow cytometery (FCM) to study the effect of leptin on the proliferation and apoptosis of GH3 cells. We found that leptin inhibited proliferation of GH3 cells with a dose-dependent manner. And leptin reduced the proportion of cells in S phase, increased the proportion of cells in G1, and increased the proportion of GH3 cells in 2 and 4 phase. These results demonstrate that leptin inhibits the basal GH secretion of GH3 cells, which may be due to the inhibition of DNA synthesis and advanced apoptosis of GH3 cells.
Adenoma ; metabolism ; pathology ; Animals ; Apoptosis ; physiology ; Cell Line, Tumor ; Cell Proliferation ; Growth Hormone ; secretion ; Leptin ; physiology ; Pituitary Neoplasms ; metabolism ; pathology ; Rats