Pituitary function tests
Pituitary function tests demonstrated elevation of IGH-1 with other levels been normal/low.
- THYROID FUNCTION
- FT4 10.9 pmol/L (normal: 9.0-26.0)
- FT3 3.6 pmol/L (normal: 3.5-6.5)
- TSH 0.52 mIU/L (normal: 0.1-4.0)
- REPRODUCTIVE HORMONES
- LH 4.5 IU/L (normal: 1.5-9.3)
- FSH 8.8 IU/L (normal: 1.4-18.1)
- Testosterone 1.5L nmol/L (normal: 7-28)
- Prolactin 21L mIU/L (normal: 45-375)
- GROWTH HORMONES
- IGF-1 141.0H nmol/L (normal: 14.2-36.9)
- CORTISOL
- Plasma Cortisol 14L nmol/L (normal: 120-650)
Histology
The patient went onto have a transsphenoidal resection.
MICROSCOPIC DESCRIPTION: Paraffin sections show fragments of a moderately hypercellular adenoma. Tumour cells have uniform round and oval nuclei and a variable amount of pale granular eosinophilic cytoplasm. These are arranged in diffuse sheets within a vascular stroma. No mitotic figures are identified. Areas of haemorrhagic infarction are present. No normal anterior pituitary tissue is included.
Immunohistochemistry shows patchy weak staining in viable cells for growth hormone. There is also strong perinuclear staining for CAM5.2 in the majority of tumour cells. A moderate number of cells show staining for prolactin.
No staining for ACTH, LH, FSH, TSH, GFAP or S-100 protein is seen. The topoisomerase labelling index is approximately 1%.
FINAL DIAGNOSIS:
Pituitary adenoma with partial haemorrhagic infarction and immunohistochemical profile suggestive of sparsely granulated growth hormone secreting adenoma.