From macroprolactinoma to concomitant ACTH-PRL hypersecretion with Cushing's disease

Multiple pituitary hormone hypersecretions have been already described, but the combination of PRL and ACTH excess is rare. This report deals with a 4 2-yr-old woman affected by macroprolactinoma (PRL 12,720 mu g/l, huge tumor with extrasellar extension at imaging). After one year on dopaminergic tre atment causing PRL normalization and tumor shrinkage, she developed hyperco rtisolism (UFC 1,000 mu g/24 h, ACTH 200 ng/l). Gushing's disease was diagn osed. After neurosurgery (at immunocytochemistry mixed ACTH-PRL adenoma was shown) hypercortisolism remitted, whereas pathological hyperprolactinemia with tumor remnant in cavernous sinus persisted and hypopituitarism develop ed. The patient reported seems atypical for the following reasons: 1) the c oncomitant PRL and ACTH hypersecretions; 2) the clinical presentation with hypercortisolism following hyperprolactinemia; 3) the surgical cure of hype rcortisolism with persisting hyperprolactinemia. (J. Endocrinol, Invest. 23 : 107-111, 2000) (C)2000, Editrice Kurtis.