Plurihormonal Adenomaの1例

A Plurihormonal Adenoma:A case report

I．はじめに

　2種類以上のホルモンを産生するplurihormonal ade—nomaは，外科的に切除されたpituitary adenomaの約14％を占めるとされる^6）．その中では，acromegalyにおけるプロラクチン（PRL）産生の合併が大部分を占めるが，一方で様々なホルモンの組み合わせも報告されている^6,8,16）．今回われわれは，臨床的にhyper-prolactin—emiaの症状を呈しながら，成長ホルモン（GH）産生を合併したplurihormonal adenomaを経験したので報告する．

A case of prolactinoma secreting growth hormone reported.

A 32-year-old woman was admitted to our hospital complaining of galactorrhea, amenorrhea and bitempo-ral hemianopsia. She showed hyperprolactinemia about 500ng/ml and elevated growth hormone level over 10ng/ml without clinical features of acromegaly. Static perimetry represented typical bitemporal hemianopsia better than kinetic perimetry in the early stage of this pituitary tumor. Her visual acuity was 1.0 on the right and 0.02 on the left. MR images showed the intra-and suprasellar mass lesion compressing the optic nerves especially on the left. Because her visual acuity deteriorated rapidly, trans-sphenoidal tumor resection was carried out twelve days after admission. Total removal was achieved. Postop-erative MRI showed that the normal pituitary gland had been preserved. The patient's visual acuity re-coverd to 1.2 on the right and 0.9 on the left, and bitemporal hemianopsia improved remarkably. Postop-erative course was uneventful and hormonal functions were normalized.

Histological examination showed that the tumor was chromophobe adnoma. The adnoma cells showed im-munopositivity for growth hormone, but not for prolac-tin. Such absence of prolactin granules within cyto-plasm might be due to the difference in antigen pro-duced by the adenomatous gland as compared with that produced by the normal gland.

Although hyperprolactinemia is often observed in acromegaly, hypersecretion of growth hormone in pro-lactinoma as was found in this case is very rare in medical literture.