Acromegaly with normal growth-hormone levels and pituitary histology

Case report

Restricted access

✓ In rare cases, acromegalic patients have normal basal concentrations of growth hormone, and their acromegaly results from abnormal growth-hormone secretory patterns. A patient is reported with the clinical features of acromegaly, who had elevated somatomedin levels and an enlarged sella turcica, but whose serum growth-hormone levels on continuous monitoring were in the normal range, with levels of 2.8 to 8.9 ng/ml. Dynamic studies of growth hormone revealed normal responses to hypo- and hyperglycemia, but abnormal responses to L-dopa and thyroid-releasing hormone. At surgery, neither a pituitary adenoma nor eosinophilic hyperplasia was present. It is likely that this patient's acromegaly resulted from the presence of chronically high normal levels of growth hormone.

Article Information

Contributor Notes

Address reprint requests to: Kenneth R. Feingold, M.D., Veterans Administration Hospital, 4150 Clement Street, San Francisco, California 94121.
Headings
References
  • 1.

    Abreau CVagenakis AAzizi Fet al: A single method for measuring total thyroxine and free thyroxine index in serum. J Nucl Med 14:7407421973Abreau C Vagenakis A Azizi F et al: A single method for measuring total thyroxine and free thyroxine index in serum. J Nucl Med 14:740–742 1973

    • Search Google Scholar
    • Export Citation
  • 2.

    Bailey PDavidoff LM: Concerning the microscopic structure of the hypophysis cerebri in acromegaly. (Based on a study of tissue removed at operation from 35 patients.) Am J Pathol 1:1852071925Bailey P Davidoff LM: Concerning the microscopic structure of the hypophysis cerebri in acromegaly. (Based on a study of tissue removed at operation from 35 patients.) Am J Pathol 1:185–207 1925

    • Search Google Scholar
    • Export Citation
  • 3.

    Becker DPAtkinson RSakalas Ret al: Transphenoidal microsurgery for acromegaly. Successful treatment with preservation of pituitary function. Confin Neurol 36:1011051974Becker DP Atkinson R Sakalas R et al: Transphenoidal microsurgery for acromegaly. Successful treatment with preservation of pituitary function. Confin Neurol 36:101–105 1974

    • Search Google Scholar
    • Export Citation
  • 4.

    Chiodini PGLiuzzi ABotalla Let al: Inhibitory effect of dopaminergic stimulation on GH release in acromegaly. J Clin Endocrinol Metab 38:2002061974Chiodini PG Liuzzi A Botalla L et al: Inhibitory effect of dopaminergic stimulation on GH release in acromegaly. J Clin Endocrinol Metab 38:200–206 1974

    • Search Google Scholar
    • Export Citation
  • 5.

    Chochinov RHDaughaday WH: Currect concepts of somatomedin and other biologically related growth factors. Diabetes 25:99410041976Chochinov RH Daughaday WH: Currect concepts of somatomedin and other biologically related growth factors. Diabetes 25:994–1004 1976

    • Search Google Scholar
    • Export Citation
  • 6.

    Cryer PEDaughaday WH: Regulation of growth hormone secretion in acromegaly. J Clin Endocrinol Metab 29:3863931969Cryer PE Daughaday WH: Regulation of growth hormone secretion in acromegaly. J Clin Endocrinol Metab 29:386–393 1969

    • Search Google Scholar
    • Export Citation
  • 7.

    Dabek JT: Bronchial carcinoid tumour with acromegaly in two patients. J Clin Endocrinol Metab 38:3293331974Dabek JT: Bronchial carcinoid tumour with acromegaly in two patients. J Clin Endocrinol Metab 38:329–333 1974

    • Search Google Scholar
    • Export Citation
  • 8.

    Daughaday WH: The adenohypophysis in Williams RH (ed): Textbook of Endocrinologyed 5. Philadelphia: WB Saunders1974 pp 3179Daughaday WH: The adenohypophysis in Williams RH (ed): Textbook of Endocrinology ed 5. Philadelphia: WB Saunders 1974 pp 31–79

    • Search Google Scholar
    • Export Citation
  • 9.

    Decker REEpstein JACarras Ret al: Transsphenoidal microsurgery for pituitary tumors: experience with 45 cases. Mt Sinai J Med NY 43:5655771976Decker RE Epstein JA Carras R et al: Transsphenoidal microsurgery for pituitary tumors: experience with 45 cases. Mt Sinai J Med NY 43:565–577 1976

    • Search Google Scholar
    • Export Citation
  • 10.

    Dott NMBailey P: A consideration of the hypophysial adenomata. Br J Surg 13:3143661925Dott NM Bailey P: A consideration of the hypophysial adenomata. Br J Surg 13:314–366 1925

    • Search Google Scholar
    • Export Citation
  • 11.

    Gordon DAHill FMEzrin C: Acromegaly: A review of 100 cases. Can Med Assoc J 87:110611091962Gordon DA Hill FM Ezrin C: Acromegaly: A review of 100 cases. Can Med Assoc J 87:1106–1109 1962

    • Search Google Scholar
    • Export Citation
  • 12.

    Hardy J: Transsphenoidal surgery of hypersecreting pituitary tumors in Kohler PORoss GT: Diagnosis and Treatment of Pituitary Tumors. Amsterdam: Excerpta Medical International Congress Series No. 3031973 pp 179194Hardy J: Transsphenoidal surgery of hypersecreting pituitary tumors in Kohler PO Ross GT: Diagnosis and Treatment of Pituitary Tumors. Amsterdam: Excerpta Medical International Congress Series No. 303 1973 pp 179–194

    • Search Google Scholar
    • Export Citation
  • 13.

    Herington ACJacobs LSDaughaday WH: Radioreceptor and radioimmunoassay quantitation of human growth hormone in acromegalic serum: overestimation by immunoassay and systemic differences between antisera. J Clin Endocrinol Metab 39:2572621974Herington AC Jacobs LS Daughaday WH: Radioreceptor and radioimmunoassay quantitation of human growth hormone in acromegalic serum: overestimation by immunoassay and systemic differences between antisera. J Clin Endocrinol Metab 39:257–262 1974

    • Search Google Scholar
    • Export Citation
  • 14.

    Irie MTsushimi T: Increase of serum growth hormone concentration following thyrotropin-releasing hormone injection in patients with acromegaly or gigantism. J Clin Endocrinol Metab 35:971001972Irie M Tsushimi T: Increase of serum growth hormone concentration following thyrotropin-releasing hormone injection in patients with acromegaly or gigantism. J Clin Endocrinol Metab 35:97–100 1972

    • Search Google Scholar
    • Export Citation
  • 15.

    Lewis PDVan Noorden S: Pituitary abnormalities in acromegaly. Arch Pathol 94:1191261972Lewis PD Van Noorden S: Pituitary abnormalities in acromegaly. Arch Pathol 94:119–126 1972

    • Search Google Scholar
    • Export Citation
  • 16.

    Liuzzi AChiodini PGBotalla Let al: Inhibitory effect of L-dopa on GH release in acromegalic patients. J Clin Endocrinol Metab 35:9419431972Liuzzi A Chiodini PG Botalla L et al: Inhibitory effect of L-dopa on GH release in acromegalic patients. J Clin Endocrinol Metab 35:941–943 1972

    • Search Google Scholar
    • Export Citation
  • 17.

    Lüdecke DKautzky RSaeger Wet al: Selective removal of hypersecreting pituitary adenomas? An analysis of endocrine function, operative and microscopical findings in 101 cases. Acta Neurochir 35:27421976Lüdecke D Kautzky R Saeger W et al: Selective removal of hypersecreting pituitary adenomas? An analysis of endocrine function operative and microscopical findings in 101 cases. Acta Neurochir 35:27–42 1976

    • Search Google Scholar
    • Export Citation
  • 18.

    Marshall RNUnderwood LEVoina SJet al: Characterization of the insulin and somatomedin-C receptors in human placental cell membranes. J Clin Endocrinol Metab 39:2832921974Marshall RN Underwood LE Voina SJ et al: Characterization of the insulin and somatomedin-C receptors in human placental cell membranes. J Clin Endocrinol Metab 39:283–292 1974

    • Search Google Scholar
    • Export Citation
  • 19.

    Mims RBBethune JE: Acromegaly with normal fasting growth hormone concentrations but abnormal growth hormone regulation. Ann Intern Med 81:7817841974Mims RB Bethune JE: Acromegaly with normal fasting growth hormone concentrations but abnormal growth hormone regulation. Ann Intern Med 81:781–784 1974

    • Search Google Scholar
    • Export Citation
  • 20.

    Nakagawa KObara T: Failure of growth hormone-suppressing agents to affect TSH-releasing hormone- and LH-releasing hormone-induced growth hormone release in acromegaly. J Clin Endocrinol Metab 44:1891931977Nakagawa K Obara T: Failure of growth hormone-suppressing agents to affect TSH-releasing hormone- and LH-releasing hormone-induced growth hormone release in acromegaly. J Clin Endocrinol Metab 44:189–193 1977

    • Search Google Scholar
    • Export Citation
  • 21.

    Pelkonen RGrahne B: Treatment of acromegaly by transsphenoidal hypophysectomy with cryoapplication. Clin Endocrinol 4:53641975Pelkonen R Grahne B: Treatment of acromegaly by transsphenoidal hypophysectomy with cryoapplication. Clin Endocrinol 4:53–64 1975

    • Search Google Scholar
    • Export Citation
  • 22.

    Sönksen PHAyres ABBraimbridge Met al: Acromegaly caused by pulmonary carcinoid tumours. Clin Endocrinol 5:5035131976Sönksen PH Ayres AB Braimbridge M et al: Acromegaly caused by pulmonary carcinoid tumours. Clin Endocrinol 5:503–513 1976

    • Search Google Scholar
    • Export Citation
  • 23.

    Sung LCCavalieri RP: A method for determining both total serum thyroxine and free thyroxine index in a single procedure. Clin Res 21:2051973 (Abstract)Sung LC Cavalieri RP: A method for determining both total serum thyroxine and free thyroxine index in a single procedure. Clin Res 21:205 1973 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 24.

    Takano KHall KFryklund Let al: The binding of insulin and somatomedin A to human placental membrane. Acta Endocrinol 80:14311975Takano K Hall K Fryklund L et al: The binding of insulin and somatomedin A to human placental membrane. Acta Endocrinol 80:14–31 1975

    • Search Google Scholar
    • Export Citation
  • 25.

    TSH (125I)radioimmunoassay test system: For the quantitative determination of human TSH (Thyrotropin) in serum by RIA. Medfield, Mass: Corning Medical DiagnosticsPublication RIA-1005March1977TSH (125I)radioimmunoassay test system: For the quantitative determination of human TSH (Thyrotropin) in serum by RIA. Medfield Mass: Corning Medical Diagnostics Publication RIA-1005 March 1977

    • Search Google Scholar
    • Export Citation
  • 26.

    Van Wyk JJUnderwood LE: Relation between growth hormone and somatomedin. Annu Rev Med 26:4274411975Van Wyk JJ Underwood LE: Relation between growth hormone and somatomedin. Annu Rev Med 26:427–441 1975

    • Search Google Scholar
    • Export Citation
  • 27.

    Young DGBahn RCRandall RV: Acromegaly: A review of 100 cases. Can Med Assoc J 87:110611091962Young DG Bahn RC Randall RV: Acromegaly: A review of 100 cases. Can Med Assoc J 87:1106–1109 1962

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 333 312 21
Full Text Views 212 97 0
PDF Downloads 127 34 0
EPUB Downloads 0 0 0
PubMed
Google Scholar