Pituitary Tumors
Division of Endocrinology & Metabolism
Sung-Woon Kim, MD
Pituitary tumor -
Macroadenoma
Pituitary tumors
Pituitary adenomas have specific signs and symptoms t
hat are primarily related to the endocrinopathies produ
ced by hypersecretion.
Prolactinoma
Prolactinoma
The prolactin-secreting pituitary adenomas are the mos
t common, and account for approximately 30% of all p
ituitary tumors.
She was well with Bromocriptine 2.5 mg (1/2 tab.) QD and had regular menstruation until Aug. 1997
오 O 숙 ( F/45 ) OPD : 98.2.10
She was OPD visit for evaluation of amenorrhea and g alactorrhea. (7-8 yrs duration)
She had no specific medical history and habits except ame norrhea & galactorrhea, but previously checked serum PRL showed over 236 ng/mL.
Height 152.5 cm Weight 46kg BMI 20.63 kg/m2 Vital signs 120/80 -82 -20 -36.5
7
Combined pituitary stimulation test
T3 97 ng/dL T4 6.4 ng/dL E2 122.5 pg/mL Progesterone 0.02 ng/mL Testosterone UD -30 0 30 60 90 120 Glucose 92 27 56 74 88 ACTH (15-90 pg/mL) 17.0 17.9 28.1 204.7 83.7 71.8 Cort (5-13 mg/mL) 8.8 10.9 16.5 26.0 27.5 28.8 GH ( <5 ng/mL) 0.2 0.1 0.3 10.2 7.7 3.6 FSH (1.4-9.6IU/L) 7.1 31.6 50.5 49.1 53.2 LH (0.8-26 IU/L) 11.0 63.7 65.9 61.0 42.9 PRL (2-15 ng/mL) >236 >236 >236 >237 >236
Bromocriptine 5 mg bid.
GH producing tumor
The endocrinopathy of excess growth hormone results i
n enlargement of the extremities, face and the soft tissu
es, producing a characteristic appearance called acrome
galy.
Acromegaly can be associated with hypertension, di
abetes mellitus and cardiovascular disease.
His symptoms were aggravated and checked at local ENT and then, local ENT doctor recommended him to
endocrinologist for acromegalic features.
최
최 OO 용용 (M/44)(M/44)
OPD : 98.2.10 He was well until 20 days before admission, but he had a bout of headache, nausea and vomiting.
He had adult type DM for 5 years, but had ignored to treatment.
68 68
44 41 38 36 37
15
Review of System
He was suffered from fatigue, sweating, headache, dizziness, Heavy snoring, enlarging hands and feet and decreased libido.
Physiacal Examination
He had prognathism, moist, warm, and fleshy skin. He had large tongue, widely spaced teeth
Height :173cm Weight: 75 kg BMI: 25.86 kg/m2 V/S : 130/90 mmHg - 80/min - 20/min - 36.6 C
He had been diabetic for 5 years, and his FBS
showed 146mg/dL and postprandial 2 hour glucose, 267 mg/dL
진단은 ?
1. Acromegaly
2. type 2 DM
R/O secondary D
M
Dynamic GH profiles
Basal GH secretion
8:30 9:00 9:30 10:00 10:30 11:00
GH 8.9 8.9 9.1 8.9 7.6 8.6
GH suppression test by octreotide
-30 0 30 60 90 120
GH 15 17.1 2.6 1.8 0.7 0.7
GH stimulation test by GHRH
-30 0 30 60 90 120
Acromegaly
Cushing’s disease
Cushing's syndrome results from hypercortisolism and is chara cterized by distinctive clinical features.
Patients may develop obesity, hirsutism (abnormal hair distribut ion), purple striae (stripes) on the skin, mental problems, poor wound healing and muscle wasting.
She was well with antihypertensive regimen for
The last 5 years. One month ago, she had generalized
edema(?), but local doctor suggested Cushing’s syndrome. 김 O 순 ( F/60 )
Adm : 98.7.20 She was suffered from generalized weakness for a
Systemic Review
She had 5 kg of weight gain since last year (59 to 64 kg), easy fa tigability, generalized and facial edema, easy bruisibility, oligome norrhea and menstrual irregulality.
Physical Examination
Height 153 cm, Weight 64 kg, BMI : 27.3 kg/m2
Vital signs BP 150/90 mmHg TPR 36-74-20
Impression :
Cushing’s syndromeDiagnostic plan :
1. 24hr urine free cortisol, plasma ACTH level
2. Screening of 1mg dexamethasone suppression test 3. Confirmatory test
low-dose dexamethasone suppression test high-dose dexamethasone suppression test 4. Pituitary imaging - Sella MRI
Bone densitometry ; within normal limits.
외부 Abdomen CT ; both renal cysts
5 Day Dexamethasone suppression test (98-4-18)
Days PlasmaACTH (pg/mL) Serum Cortisol (g/dL) 24 hr. urine 17OHCS 17KS fCORT Cr. 1 Basal 8 am 54.8 13.6 11.4 12.8 222.9 0.6 4 pm 85.9 17.0 3 Low Dose 8 am 53.5 7.1 11.4 7.5 54.6 1.2 4 pm 31.3 2.4 5 High Dose 8 am 21.5 2.3 6.6 2.4 19.2 0.9
Oral glucose tolerance Test (98-4-24)
0 30 60 90 120
Glucose (mg/dL) 97 195 257 273 273
Insulin (U/mL) 10.1 25.9 44.4
Inferior Petrosal Sinus Sampling (98-4-28) ACTH (pg/mL) 0 3 6 8 10 Left 28.0 46.3 73.5 82.1 81.9 Right 200.5 >2175 >2175 >2175 >2175 Pph 29.0 33.7 66.2 64.5 74.4 Lt pph. 0.9 1.3 1.1 1.2 1.1 CRH 100 CRH 100 g iv.g iv.
Diagnosis :
Cushing’s disease MicroadenomaTherapeutic plan :
Overnight dexamethasone suppression test (98-8-22)
Days PlasmaACTH (pg/mL) Serum Cortisol (g/dL) 24 hr. urine 17OHCS 17KS fCORT Cr. 1 Basal 8 am 15.6 9.3 7.5 6.7 12.2 0.6 4 pm 9.9 3.1 2 Over-night 8 am 6.3 1.7 4.9 2.6 1.7 0.6 4 pm 3.5 1.1
Oral glucose tolerance Test (98-8-25) 0 30 60 90 120 Glucose (mg/dL) 91 134 153 166 149 Insulin (U/mL) 12.8 28.7 34.8 C-peptide (ng/mL) 4.3 5.1 HbA1C : 6.0%,
Combined pituitary stimulation test
(98-4-30)
-30 min 0 min 30 min 60 min 90 min 120 min
glucose (mg/dL) 111 48 63 81 84 ACTH (pg/mL) 42.1 38.3 37.2 21.6 20.5 28.1 Cortisol (ug/dL) 13.6 17.0 7.1 2.4 1.3 1.0 GH (ng/mL) 0.7 2.4 1.8 1.2 1.0 1.8 FSH ( IU/L ) 84.7 101.9 113.1 116.3 133.7 LH ( IU/L ) 11.7 63.5 60.2 51.5 26.7 PRL (ng/mL) 19.6 122.8 112.8 79.3 56.7 T3 61 ng/dL T4 4.9 ug/dL TSH 0.12 uU/mL
