Gheri R G, Boddi W, Ammannati F, Olivotto J, Nozzoli C, Franchi A, Bordi L, Luisi M L, Mennonna P
Dip. di Fisiopatologia Clinica, Università di Firenze, Azienda Ospedaliera Careggi, Italy.
J Endocrinol Invest. 1997 Apr;20(4):240-4. doi: 10.1007/BF03346911.
In this report we describe the case of a young female patient with amenorrhea-galactorrhea syndrome apparently due to pituitary PRL-secreting adenoma who, after three years of dopaminergic therapy without any shrinkage of the tumor, developed true Cushing's disease. Progression from hyperprolactinemia to hypersecretion of ACTH has been rarely described and it may be due to different possibilities. However, histopathological and immunohistochemical studies of the adenoma showed a pattern of PRL negative and ACTH positive cells, excluding mixed pituitary tumor. In order to explain the progression from hyperprolactinemia with amenorrhea-galactorrhea to an ACTH hypersecretion syndrome, it must be hypothesized either pituitary stalk compression or the influence of paracrine regulation factor(s) (such as Galanine) due to an "initially silent" corticotropinoma. This case confirms that the presence of hyperprolactinemia in a patient with pituitary tumor and amenorrhea-galactorrhea syndrome is insufficient to confidently conclude for prolactinoma. Furthermore, it underlines the importance both of clinically monitoring the patient with prolactin pituitary adenoma if dopaminergic therapy does not reduce tumor volume, and of accurately and repeatedly measuring the other pituitary hormonal secretions.
在本报告中，我们描述了一例年轻女性患者，患有闭经 - 溢乳综合征，显然是由垂体分泌泌乳素的腺瘤引起。在接受三年多巴胺能治疗后肿瘤未出现任何缩小，随后该患者发展为真性库欣病。从高泌乳素血症进展为促肾上腺皮质激素（ACTH）分泌过多的情况鲜有报道，可能存在多种原因。然而，对腺瘤的组织病理学和免疫组织化学研究显示，腺瘤细胞呈现泌乳素阴性、ACTH阳性的模式，排除了混合性垂体瘤。为了解释从伴有闭经 - 溢乳的高泌乳素血症进展为ACTH分泌过多综合征的原因，必须假设存在垂体柄受压，或者是由于“最初无症状”的促肾上腺皮质激素瘤导致旁分泌调节因子（如甘丙肽）的影响。该病例证实，垂体瘤和闭经 - 溢乳综合征患者存在高泌乳素血症不足以确诊为泌乳素瘤。此外，它强调了如果多巴胺能治疗未能减小肿瘤体积，对泌乳素垂体腺瘤患者进行临床监测的重要性，以及准确且反复测量其他垂体激素分泌的重要性。
