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Acromegaly and Somatotroph Hyperplasia with Adenomatous Transformation Due to Pituitary Metastasis of a Growth Hormone-Releasing Hormone-Secreting Pulmonary Endocrine Carcinoma

Departments of Endocrinology and Metabolism (C.N.), Neurological Surgery (A.M.), and Neurosciences and Anatomic Pathology (S.M.S.), Cleveland Clinic, Cleveland, Ohio 44195; Seattle Neuroscience Institute (M.M.), Seattle, Washington 98122; and Department of Laboratory Medicine and Pathobiology (S.L.A.), University of Toronto, Toronto, Ontario, Canada M5G 2M9

Address all correspondence and requests for reprints to: Dr. Christian Nasr, Staff, Department of Endocrinology and Metabolism, The Cleveland Clinic Foundation, A53, 9500 Euclid Avenue, Cleveland, Ohio 44195. E-mail: nasrc{at}ccf.org.

Context: GHRH excess from extracranial endocrine tumors is known to cause somatotroph hyperplasia and acromegaly. Hypothalamic gangliocytomas producing GHRH are also known to be associated with pituitary adenomas causing acromegaly.

Objectives: The objective of this study was to describe a case of acromegaly due to a pulmonary GHRH-secreting endocrine carcinoma with metastasis to the pituitary gland and to look at the peculiar histological features of this case.

Subject: The patient was a 44-yr-old woman who was diagnosed with a biopsy-proven metastatic pulmonary endocrine tumor during pregnancy. After delivery, she underwent radiation and chemotherapy for pulmonary and skeletal metastases. Her disease was clinically stable for 7 yr until she developed bitemporal hemianopia. She had symptoms and signs of acromegaly.

Methods: Imaging, biochemical, and histological studies were performed.

Results: Magnetic resonance imaging (MRI) of the brain confirmed the presence of a 2.6-cm lesion within the sella turcica extending above the sella and compressing the optic chiasm. Endocrine studies showed elevated serum levels of GH, prolactin, -subunit of glycoprotein hormones, IGF-I, chromogranin A, and GHRH. The patient underwent uneventful transsphenoidal resection of the sellar tumor. Postoperatively, she noted an improvement in symptoms of acromegaly. Histological examination confirmed metastatic endocrine carcinoma to the pituitary, and immunohistochemistry localized GHRH to the tumor cells. The adjacent pituitary exhibited somatotroph hyperplasia with abundant reactivity for GH and -subunit. In addition, there was focal neoplastic transformation to a sparsely granulated somatotroph phenotype with fibrous bodies.

Conclusion: This is the first report of a GHRH-producing endocrine tumor metastasizing to the pituitary and causing local hyperstimulation with somatotroph hyperplasia and adenomatous transformation.