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Apparently Silent Somatotroph Adenomas

Pathology - Research and Practice
Publication Date
DOI: 10.1016/s0344-0338(11)81066-6
  • Acromegaly
  • Basal Plasma Gh
  • Somatotroph Adenoma
  • Biology
  • Chemistry
  • Medicine


Summary We describe here 9 patients with somatotroph adenomas associated with mild features of acromegaly and basal plasma GH levels in the normal range. In 5 women and 4 men, 26 to 61 yrs old, the diagnosis of prolactinoma or non-secreting pituitary adenoma had been previously made on the basis of amenorrhea-galactorrhea or tumoral symptoms. However, they had discrete signs of coarsening of the facial features and moderate but evolutive changes of hand and foot sizes. Basal GH levels were in the normal range (0.4 to 4.5 μg/l, N < 5 μg/l) but unaffected by oral glucose and insulin tolerance tests while IGF-I concentrations were elevated in all the cases (range 1.7 to 5.8 U/ml, N: 0.37–1.41 U/ml). Plasma PRL concentrations were elevated in 5 patients (range 16 to 80 μg/l, N < 13 μg/l in men and N < 19 μg/l in women). The 9 patients had a macroadenoma with an extrasellar extension in 8 of them and all were operated on by the transsphenoidal route. Immunocytochemical studies demonstrated IRGH-cells in all the adenomas and IRPRL-cells in 5 of them. Electron microscopic analysis of 3 tumors showed that the secretory granules were sparse and the Golgi apparatus poorly developed. Molecular biology of 7 tumors showed the presence of small amounts of GH mRNA. This result was in agreement with the morphological aspect, suggesting a low rate of GH synthesis. Thanks to these different approaches the diagnosis of silent somatotroph adenoma should sometimes be reconsidered. It may correspond, like in our cases, to apparently silent somatotroph adenomas. The question arises whether these cases represent a distinct entity towards usual cases of acromegaly or if they correspond to the beginning or to a mild aspect of the disease.

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