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Fukunaga K, Imachi H, Sato S, Kobayashi T, Yoshioka Y, Saheki T, Ban N, Urushihara K, Lyu J, Dong T, Ishikawa R, Kadota K, Haba R, Inoshita N, Murao K. Successful Therapy Using Pasireotide Long-acting Release for Cushing's Disease Merged with Biochemical Acromegaly. Intern Med 2021; 60:1047-1053. [PMID: 33162471 PMCID: PMC8079926 DOI: 10.2169/internalmedicine.4663-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
It is quite rare that Cushing's disease shows acromegaly, and no pharmacotherapy has yet been discussed. A 21-year-old woman was diagnosed with Cushing's disease and underwent trans-sphenoidal surgery. Five years later, she was diagnosed with recurrent Cushing's disease and biochemical acromegaly because of elevated levels of serum growth hormone (GH), plasma insulin-like growth factor-1, plasma adrenocorticotropic hormone (ACTH), and the 24-hour urinary excretion of free cortisol. After treatment initiation with pasireotide-long-acting release (LAR), both the ACTH and GH declined. Our case is the first to show the efficacy of pasireotide-LAR in controlling both Cushing's disease and acromegaly.
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Affiliation(s)
- Kensaku Fukunaga
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Hitomi Imachi
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Seisuke Sato
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Toshihiro Kobayashi
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Yuki Yoshioka
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Takanobu Saheki
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Natsuki Ban
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Kurumi Urushihara
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Jingya Lyu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Tao Dong
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Ryou Ishikawa
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Japan
| | - Kyuichi Kadota
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Japan
| | - Reiji Haba
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Japan
| | - Naoko Inoshita
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Japan
| | - Koji Murao
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
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Torregrosa-Quesada ME, García-Martínez A, Silva-Ortega S, Martínez-López S, Cámara R, Fajardo C, Lamas C, Aranda I, Picó A. How Valuable Is the RT-qPCR of Pituitary-Specific Transcription Factors for Identifying Pituitary Neuroendocrine Tumor Subtypes According to the New WHO 2017 Criteria? Cancers (Basel) 2019; 11:cancers11121990. [PMID: 31835737 PMCID: PMC6966694 DOI: 10.3390/cancers11121990] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 11/16/2022] Open
Abstract
The classification of pituitary neuroendocrine tumors (PitNETs) subtypes continues generating interest. In 2017, the World Health Organization (WHO) proposed considering the immunohistochemical (IHC) analysis of pituitary-specific transcription factors (TF) for their typification. The present study targeted the quantification of pituitary-specific TF (TPIT, PIT-1, SF-1, GATA2, ESR1) gene expression by RT-qPCR to overcome the shortcomings of IHC and to complement it. We analyzed 251 tumors from our collection of PitNETs and performed additional IHC studies in a subset of 56 samples to analyze the concordance between gene and protein expression of the TF. The molecular and IHC studies allowed us to significantly reduce the percentage of null cell tumors in our series, most of which were reclassified as gonadotroph tumors. The concordance between the molecular and the immunohistochemical studies was good for tumors coming from the corticotroph and Pit-1 lineages but worsened for the rest of the tumors. Indeed, the RT-qPCR helped to improve the typification of plurihormonal Pit-1 and unusual tumors. Overall, our results suggest that the RT-qPCR of pituitary-specific TF and hormone genes could help pathologists, endocrinologists, and neurosurgeons to improve the management of patients with pituitary tumors.
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Affiliation(s)
| | - Araceli García-Martínez
- Research Laboratory, Hospital General Universitario de Alicante -ISABIAL, 03010 Alicante, Spain; (A.G.-M.); (S.M.-L.)
| | - Sandra Silva-Ortega
- Pathology Department, Hospital General Universitario de Alicante, 03010 Alicante, Spain; (S.S.-O.); (I.A.)
| | - Sebastián Martínez-López
- Research Laboratory, Hospital General Universitario de Alicante -ISABIAL, 03010 Alicante, Spain; (A.G.-M.); (S.M.-L.)
| | - Rosa Cámara
- Endocrinology Department, Hospital Universitario Politécnico La Fe, 46026 Valencia, Spain;
| | - Carmen Fajardo
- Endocrinology Department, Hospital Universitario La Ribera, Alzira, 46600 Valencia, Spain;
| | - Cristina Lamas
- Endocrinology Department, Complejo Universitario de Albacete, 02006 Albacete, Spain;
| | - Ignacio Aranda
- Pathology Department, Hospital General Universitario de Alicante, 03010 Alicante, Spain; (S.S.-O.); (I.A.)
| | - Antonio Picó
- Endocrinology Department, Hospital General Universitario de Alicante -ISABIAL, Miguel Hernández University, 03010 Alicante, Spain
- Correspondence: ; Tel.: +34-659467594
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