Matsuno Akira, Okazaki Ryo, Oki Yutaka, Nagashima Tadashi
Department of Neurosurgery, Teikyo University Ichihara Hospital, Ichihara City, Chiba, Japan.
J Neurosurg. 2004 Nov;101(5):874-7. doi: 10.3171/jns.2004.101.5.0874.
The authors report a case in which a patient harbored a corticotroph macroadenoma that secreted biologically inactive high-molecular-weight adrenocorticotropic hormone (ACTH) as well as authentic ACTH 1-39. The secretion of the high-molecular-weight ACTH was determined using gel chromatography. The authors believe that these two molecules competed with each other at the ACTH receptor and, thus, the bioactivity of ACTH 1-39 was masked and Cushing features were not manifested in the patient. This type of silent corticotroph adenoma may be categorized as a clinically nonfunctioning adenoma. Plasmas from patients with silent corticotroph adenomas, which are identified by positive immunohistochemical staining of ACTH, should be frozen, stored, and analyzed using gel chromatography to examine whether the tumors produce and secrete high-molecular-weight ACTH.
作者报告了一例患者，其患有促肾上腺皮质激素大腺瘤，该腺瘤分泌生物活性无的高分子量促肾上腺皮质激素（ACTH）以及真正的促肾上腺皮质激素1-39。使用凝胶色谱法测定高分子量促肾上腺皮质激素的分泌情况。作者认为这两种分子在促肾上腺皮质激素受体处相互竞争，因此，促肾上腺皮质激素1-39的生物活性被掩盖，该患者未表现出库欣特征。这种类型的沉默促肾上腺皮质激素腺瘤可归类为临床无功能腺瘤。通过促肾上腺皮质激素免疫组化染色阳性鉴定出的沉默促肾上腺皮质激素腺瘤患者的血浆，应进行冷冻、储存，并使用凝胶色谱法进行分析，以检查肿瘤是否产生和分泌高分子量促肾上腺皮质激素。
