A case of fugitive acromegaly, initially presented as invasive prolactinoma

Jung Soo Lim, Cheol Ryong Ku, Mi Kyung Lee, Tai Seung Kim, Sun Ho Kim, Eun Jig Lee

Research output: Contribution to journalArticle

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Abstract

Fugitive acromegaly is most commonly caused by pituitary acidophil stem cell adenomas, and is characterized by a relatively short clinical history, a large and locally invasive tumor, and relatively low hormonal activity. Here, we report an unusual case of fugitive acromegaly that initially presented as invasive prolactinoma. A 48-year-old man with a huge pituitary mass extending to the suprasellar area was referred to our hospital in December 2007. He had undergone transsphenoidal surgery in November 1999 because of a large invasive prolactinoma. The tumor had grown progressively, despite therapy with dopamine agonists. Subtle features of acromegaly were noted and serum IGF-1 levels were high (733 ng/ml). An oral glucose tolerance test revealed that basal and nadir levels of growth hormone (GH) were 1.56 and 1 ng/ml, respectively. As a therapeutic trial, long-acting octreotide (20 mg IM, monthly) was added, and the tumor size markedly reduced within 6 months on magnetic resonance imaging examination. Immunohistochemical staining of the tumor tissue obtained at the surgery in 1999 showed positive staining for GH and prolactin (PRL). Double immunofluorescence staining showed a mixed positivity for GH and PRL in the majority of tumor cells; however, the two hormones colocalized in a minority of tumor cells, indicating that the tumor was composed of three different cell types (GH, PRL, and GH/PRL). The diagnosis of fugitive acromegaly was initially overlooked in this patient because of normal serum GH levels and a lack of acromegalic features, although histological evidence for GH production was present. IGF-1 determinations would be helpful for the diagnosis of fugitive acromegaly.

Original languageEnglish
Pages (from-to)1-5
Number of pages5
JournalEndocrine
Volume38
Issue number1
DOIs
Publication statusPublished - 2010 Aug 1

Fingerprint

Prolactinoma
Acromegaly
Growth Hormone
Neoplasms
Prolactin
Staining and Labeling
Insulin-Like Growth Factor I
Octreotide
Dopamine Agonists
Glucose Tolerance Test
Serum
Adenoma
Fluorescent Antibody Technique
Stem Cells
Magnetic Resonance Imaging
Hormones
Therapeutics

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Lim, Jung Soo ; Ku, Cheol Ryong ; Lee, Mi Kyung ; Kim, Tai Seung ; Kim, Sun Ho ; Lee, Eun Jig. / A case of fugitive acromegaly, initially presented as invasive prolactinoma. In: Endocrine. 2010 ; Vol. 38, No. 1. pp. 1-5.
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A case of fugitive acromegaly, initially presented as invasive prolactinoma. / Lim, Jung Soo; Ku, Cheol Ryong; Lee, Mi Kyung; Kim, Tai Seung; Kim, Sun Ho; Lee, Eun Jig.

In: Endocrine, Vol. 38, No. 1, 01.08.2010, p. 1-5.

Research output: Contribution to journalArticle

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