Mammosomatotropic Adenoma and Acromegaly; What Particularities? - Juniper Publishers

Brain, Spine & Neural Disorders - Juniper Publishers  

Abstract

Acromegaly is a rare condition, usually secondary to excessive production of somatotropic hormone (GH) by a pituitary adenoma, which is clinically expressed either by acromegaly or by gigantism depending on the age of onset. Several histological types are involved. We usually distinguish somato-prolactin adenoma. The mammosomatotropic adenoma is a particular entity, characterized by an intense anti-GH immunohistochemistry and a lower anti-prolactin immunopositivity, but within the same cell. We report 4 observations of a histological type: mammosomatotropic adenoma.

Keywords: Acromegaly Mammosomatotropic adenoma GH prolactin IGF1 Immunohistochemistry

Introduction

Acromegaly is a disease related to hypersecretion of growth hormone (GH), a pituitary adenoma somatotropic in more than 90% of cases [1,2]. She is responsible for an acquired dysmorphic syndrome, and rheumatological, cardiovascular, respiratory, metabolic, etc. consequences. Which condition the prognosis: they are indeed all the more severe as the excess of GH has been prolonged and important [3,4]. The severity of acromegaly can also, of course, stem from the pituitary tumor that is the cause, and which can be the cause of a tumor syndrome, marked by headaches and / or visual disturbances (by chiasmatic compression). The diagnosis of acromegaly is based on the demonstration of a high plasma concentration of GH and especially non-breakable by oral hyperglycemia (greater than 0.4 μg l-1). Once the diagnosis of acromegaly has been made, it is necessary to evaluate, by magnetic resonance imaging [MRI], the volume and possible expansions of the pituitary tumor [5-10]. Several histological types are involved. Immunohistochemistry provides conclusive evidence that significant diversity exists between tumors secreting excess growth hormone (GH). We report 4 observations of a particular histological type: mammosomatotropic adenoma.

Observation

It is about four patients consulting at the endocrinology department of Med VI University Hospital of Marrakech for an acromegaloid syndrome (in 3 cases) with a case of acrogigantism. The average age was 42.7 years, with a sex ratio H / F of 0.25. The biology has shown a high level of IGF1 in all cases, with a highprolactin level in a single patient. Magnetic resonance imaging of the hypothalamic-pituitary region has demonstrated the presence of a pituitary macroadenoma in all these patients. (Figure 1) The latter benefited from first line transsphenoidal surgery, whose anatomopathological and immunohistochemical study objectified an aspect in favor of a mamo somatotropic adenoma (Figure 2), for which our patients were all placed under cabergoline with a somatostatin analogue.

Discussion

Acromegaly is a rare condition, usually secondary to excessive production of somatotropic hormone (GH) by a pituitary adenoma, either alone or in combination with another hormone, including prolactin. We usually distinguish somato-prolactin adenoma. The mamo somatotropic adenoma is characterized by an intense anti-GH immunohistochemistry and a lower antiprolactin immunopositivity, but within the same cell. Electron microscopy confirms this granular colocalization of the two hormones. The diagnosis of pluro hormonal somatotropic adenomas requires the routine practice of immunohistochemical tests because there is no specific clinical presentation. Even if they remain rare, their treatment does not differ from the other types described in acromegaly [11-19].

Conclusion

The mamo somatotropic adenoma is very rare, characterized by an intense anti-GH immunohistochemistry and a lower antiprolactin immunopositivity, but within the same cell. Electron microscopy confirms this granular colocalization of the two hormones.

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