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GH-secreting Pituitary Adenomas : Correlation between Clinical Features, Growth Potential and Histopathological Studies Hiroshi Nishioka 1 , Kiyohiro Akada 1 , Jiro Akimoto 1 , Hiroshi Ito 1 1Department of Neurosugery, Tokyo Medical College Keyword: GH-secreting pituitary adenoma , immunohistochemistry , cytokeratin , fibrous body , growth potential pp.1019-1025
Published Date 1993/11/1
DOI https://doi.org/10.11477/mf.1406900554
  • Abstract
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We compared clinical features, including endo-crinological and radiological findings, histological features and the proliferative parameters (PCNA, MIB-1 and AgNORs) with immunohistochemical features in growth hormone (GH) secreting pitui-tary adenomas.

18 cases were divided into two groups based on immunohistochemical intracytoplasmic stainings for cytokeratin: a prominent dot-like pattern (group I, 6 cases) and a diffuse perinuclear pattern (group II, 12 cases). Patients in group I (6 females, m=37.6 years old) were younger, showed female predominancy and had a shorter history of acromegaly compared with patients in group II (7 males, 5 females, m=44.9 years old). Although the size of the adenomas tend to be larger in group I, no difference was recognized in plasma GH levels between the two groups. Increased serum prolactin (PRL) levels were accompanied more common in group I. Abnormal GH responses to TRH and LHRH injection and GH suppressions to bromo-criptine administration were more frequently noted in group II than group I. Surgical approaches were transcranial in most cases of group I and trans-sphenoidal in group II. There was no difference in surgical results as to the correction rate of GH levels between the two groups. Histopathologically, group I adenomas were mostly chromophobic, weakly positve for GH, and were generally negative for PRL and α-subunit. On the other hand, group II adenomas were mostly acidophilic, diffusely stained for GH, and were often positive for PRL and α- subunit. However, there was no significant differe-nce in proliferating parameters between the two groups.

GH secreting pituitary adenomas are known to be divided into at least two distinct subtypes according to intracytoplasmic cytokeratin distribution pat-tern. A dot-like staining of group I in our study seems to correspond to fibrous bodies, the most conspicuous morphologic marker of sparsely granulated GH adenoma, while group II adenomas are likely to be consistent with densely granulated GH adenoma. Many authors reported that sparsely granulated adenomas are larger, more aggressive, more invasive, and have a lower surgical cure rate, however, no difference were seen in proliferating parameters in our study. This convenient classifica-tion of GH secreting adenomas using immunohisto-chemistry for cytokeratin may be useful for clini-cians for assessing prognosis and making therapeu-tic decisions for residual or reccurent adenomas.


Copyright © 1993, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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