Case ReportPituitary Adenocarcinoma in an Acromegalic PatientResponse to Bromocriptine and Pituitary TestingA Review of the Literature on 36 Cases of Pituitary Carcinoma
作者:
ROBERT MOUNTCASTLE,
BETTY ROOF,
RONALD MAYFIELD,
DAVID MORDES,
JULIUS SAGEL,
PAUL BIGGS,
STEPHEN RAWE,
期刊:
The American Journal of the Medical Sciences
(OVID Available online 1989)
卷期:
Volume 298,
issue 2
页码: 109-118
ISSN:0002-9629
年代: 1989
出版商: OVID
关键词: Pituitary Carcinoma;Acromegaly;Bromocriptine;Pituitary Testing
数据来源: OVID
摘要:
There are 36 reported cases of metastatic pituitary carcinoma and almost half (44%) of these were associated with syndromes of hormonal hypersecretion. The case of a 56-year-old acromegalic man with cervical lymphatic and spinal metastases from a primary pituitary carcinoma is described. Elevated basal levels of plasma growth hormone (GH) and insulin growth factor-1/Somatomedin C (IGF-1/SmC) were found. GH levels did not increase after TRH or LHRH administration but decreased after L-Dopa and glucose. Immunostaining of the metastatic tumor for GH and electron microscopy findings confirmed the diagnosis of pituitary GH-secreting carcinoma. Striking clinical improvement and a 46% decrease in plasma GH levels wee observed with bromocriptine treatment, although IGF-1/SmC levels increased during therapy. The clinical course of most reported cases of pituitary adenocarcinoma has been one of progressive intracranial expansion of a pituitary neoplasm. In only 25% were metastatic lesions discovered antemortem, and disabling symptomatology caused by metastases was rare. Only four previously reported patients of 36 with pituitary carcinoma had acromegaly.
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