Clinico-pathological study of Cushing's disease with large pituitary adenoma

被引:30
作者
Ikeda, H [1 ]
Yoshimoto, T [1 ]
Ogawa, Y [1 ]
Mizoi, K [1 ]
Murakami, O [1 ]
机构
[1] TOHOKU UNIV, SCH MED, DEPT INTERNAL MED 2, AOBA KU, SENDAI, MIYAGI 980, JAPAN
关键词
D O I
10.1046/j.1365-2265.1997.1741013.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE To explore the biological and morphological differences between large Cushing's adenomas and small adenomas, we investigated the clinical, endocrinological, neuroradiological, and histological features of patients with large Cushing's adenomas and compared them with patients with small Cushing's adenomas. PATIENTS Five of 250 patients with Cushing's disease undergoing trans-sphenoidal operations from 1989 to 1995 had large adenomas with maximum diameters greater than 30 mm. The clinical characteristics of these five patients were compared with the 14 patients with Cushing's disease with small adenomas in our series. RESULTS Oedema, myopathy, and mental disturbance were more frequent and hypertension were less frequent among patients with large adenomas. The high-dose (8 mg) dexamethasone test did not suppress cortisol production in any of the five patients. Invasion into surrounding tissue was demonstrated by magnetic resonance imaging in all five cases. All five large adenomas had scarce or no periodic acid-Schiff-positive granules and were sparsely granulated ultrastructurally. Three tumours contained cells with honeycomb Golgi apparatus which rarely contained immature secretory granules. One Crooke's cell adenoma contained trapped or displaced secretory granules. The other tumour had dilated trans-Golgi network-derived vacuoles that contained reticular or circular electron-dense material. These findings were in striking contrast to those of small Cushing's adenomas, which showed strong PAS positivity, densely-packed granulation, and had prominent Golgi complex harbouring developing secretory granules. CONCLUSIONS We found that the tumour cells in large adenomas produced only small amounts of ACTH, and showed indications of disturbances in the regulated exocytotic pathways. These factors may account for the different clinical characteristics of Cushing's disease with large pituitary adenomas.
引用
收藏
页码:669 / 679
页数:11
相关论文
共 25 条
  • [1] ARON DC, 1995, WESTERN J MED, V162, P340
  • [2] TRANS-SPHENOIDAL MICROSURGICAL MANAGEMENT OF CUSHINGS-DISEASE - REPORT OF 100 CASES
    BOGGAN, JE
    TYRRELL, JB
    WILSON, CB
    [J]. JOURNAL OF NEUROSURGERY, 1983, 59 (02) : 195 - 200
  • [3] TRANS-SPHENOIDAL SURGERY FOR CUSHINGS-DISEASE
    FAHLBUSCH, R
    BUCHFELDER, M
    MULLER, OA
    [J]. JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, 1986, 79 (05) : 262 - 269
  • [4] MASSIVE CROOKES HYALINIZATION IN CORTICOTROPH CELL ADENOMAS OF THE HUMAN PITUITARY - A HISTOLOGICAL, IMMUNOCYTOLOGICAL, AND ELECTRON-MICROSCOPIC STUDY OF 3 CASES
    FELIX, IA
    HORVATH, E
    KOVACS, K
    [J]. ACTA NEUROCHIRURGICA, 1981, 58 (3-4) : 235 - 243
  • [5] TRANS-SPHENOIDAL PITUITARY SURGERY FOR THE TREATMENT OF CUSHINGS-DISEASE - RESULTS IN 64 PATIENTS AND LONG-TERM FOLLOW-UP STUDIES
    GUILHAUME, B
    BERTAGNA, X
    THOMSEN, M
    BRICAIRE, C
    VILAPORCILE, E
    OLIVIER, L
    RACADOT, J
    DEROME, P
    LAUDAT, MH
    GIRARD, F
    BRICAIRE, H
    LUTON, JP
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1988, 66 (05) : 1056 - 1064
  • [6] HENOMATSU N, 1993, EUROPEAN J CELL BIOL, V62, P17
  • [7] ULTRASTRUCTURAL MARKERS IN THE PATHOLOGICAL DIAGNOSIS OF PITUITARY-ADENOMAS
    HORVATH, E
    [J]. ULTRASTRUCTURAL PATHOLOGY, 1994, 18 (1-2) : 171 - 179
  • [8] USE OF AVIDIN-BIOTIN-PEROXIDASE COMPLEX (ABC) IN IMMUNOPEROXIDASE TECHNIQUES - A COMPARISON BETWEEN ABC AND UNLABELED ANTIBODY (PAP) PROCEDURES
    HSU, SM
    RAINE, L
    FANGER, H
    [J]. JOURNAL OF HISTOCHEMISTRY & CYTOCHEMISTRY, 1981, 29 (04) : 577 - 580
  • [9] CUSHINGS-DISEASE DUE TO FEMALE GONADOTROPH ADENOMA OF THE PITUITARY
    IKEDA, H
    YOSHIMOTO, T
    KOVACS, K
    HORVATH, E
    [J]. CLINICAL ENDOCRINOLOGY, 1995, 43 (03) : 383 - 386
  • [10] KLIBANSKI A, 1991, NEW ENGL J MED, V324, P822