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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 
 ENDOCRINE, Vol.38(1) : 1-5, 2010 
Journal Title
Issue Date
Acromegaly/etiology* ; Acromegaly/pathology* ; Human Growth Hormone/blood ; Humans ; Insulin-Like Growth Factor I/metabolism ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Invasiveness ; Pituitary Neoplasms/complications* ; Pituitary Neoplasms/pathology* ; Prolactin/blood ; Prolactinoma/complications* ; Prolactinoma/pathology*
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
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
Yonsei Authors
Ku, Cheol Ryong(구철룡) ORCID logo https://orcid.org/0000-0001-8693-9630
Kim, Sun Ho(김선호) ORCID logo https://orcid.org/0000-0003-0970-3848
Kim, Tai Seung(김태승)
Lee, Eun Jig(이은직) ORCID logo https://orcid.org/0000-0002-9876-8370
Lim, Jung Soo(임정수)
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