Exp Clin Endocrinol Diabetes 2010; 118(1): 68
DOI: 10.1055/s-0029-1243234
Letter to the editor

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Letter to the editor of Experimental and Clinical Endocrinology and Diabetes

Concerning the article of M. Haap, B. Gallwitz, R.Meyermann, M. Mittelbronn “Cushing`s disease associated with both pituitary microadenoma and corticotroph hyperplasia” Experimental and Clinical Endocrinology and Diabetes 117: 289–293 (2009)W. Saeger1
  • 1Marienkrankenhaus, Institute of Pathology, Hamburg
Further Information

Publication History

received 13.10.2009 first decision 27.10.2009

accepted 19.11.2009

Publication Date:
01 February 2010 (online)

The article of Haap et al. in the Experimental and Clinical Endocrinology and Diabetes 117: 289–293 (2009) has drawn my attention. In their interesting work, the authors describe an ACTH producing microadenoma of the pituitary in coincidence with nodular ACTH cell hyperplasias of the anterior lobe, emphasizing that this combination has not been published before. Motivated from this observation, I reviewed the known older literature on this topic. Back in the 1970's I worked on ACTH cell hyperplasias in combination with ACTH cell adenomas, focusing on surgical specimens of patients with Cushing's disease [5] [6] [7] which had been operated with the– at that time just invented–endoscopic transnasal transsphenoidal surgery [2].

Our key observation was that at least in some cases with Cushing's disease the ACTH adenomas developed from ACTH cell hyperplasias. This has also been observed in [1] [3] [4]. Our work was supported by findings from post-mortem pituitary studies that showed nodular hyperplasias in about 6–7% of all cases and adenomas in 8–10%, respectively. Moreover, we observed many pituitaries with transitions from hyperplasias in adenomas [9]. Focal hyperplasias precede adenomas, but the existence of multifocal hyperplasia that are the basis for the development of adenoma is demonstrable mainly in Cushing's disease with ACTH cell adenomas. However, in hyperprolactinemia Prolactin cell hypoplasia can be found also together with Prolactin cell adenomas [7] [8].

References

  • 1 Kracht J, Zimmermann HD, Hachmeister U. Immunhistologischer ACTH-Nachweis in einem R-Zellen-Adenom des Hypophysenvorderlappens bei M.  Cushing  Virchows Archiv. 1966;  340 270-275
  • 2 Lüdecke DK, Kautzky R, Saeger W. et al . Selective removal of hypersecreting pituitary adenomas ? An analysis of endocrine function, operative and microscopical findings of 101 cases.  Acta neurochir (Wien). 1976;  35 27-42
  • 3 Plotz CH, Knowlton AI, Ragan C. The natural history of Cushing's syndrome.  Amer J Med. 1952;  13 597-614
  • 4 Rovit RL, Duane TD. Cushing's syndrome and pituitary tumors Pathophysiology and ocular manifestations of ACTH-secreting pituitary adenomas.  Amer J Med. 1969;  46 416-427
  • 5 Saeger W. Zur Ultrastruktur der hyperplastischen und adenomatösen ACTH- Zellen beim Cushing-Syndrom hypothalamisch-hypophysärer Genese.  Virchows Archiv. 1974;  362 73-88
  • 6 Saeger W. Die Hypophysentumoren. Cytologische und ultrastrukturelle Klassifikation, Pathogenese, endokrine Funkftionen und Tierexperiment. G. Fischer, Stuttgart - New York 1977: 1-240
  • 7 Saeger W. Die Morphologie der paraadenomatösen Adenohypophyse Ein Beitrag zur Pathogenese der Hypophysenadenome.  Virchows Archiv. 1977;  372 299-314
  • 8 Saeger W. Normale und pathologische Morphologie des Prolactin-Zellsystems. In: Edited by Jürgensen,O.: Hyperprolaktinämie-Prolaktinome. Physiologie-Klinik-Therapie. Springer, Berlin-Heidelberg-New York-London-Paris-Tokyo 1988: 27-58
  • 9 Saeger W, Schmidt W. Vor- und Frühformen der Hypophysenadenome Histologische und statistische Untersuchungen am unausgewählten Sektionsgut.  Verh Dtsch Ges Path. 1979;  63 409-415

Correspondence

Prof.Dr. W. Saeger

Institut für Pathologie des

Marienkrankenhauses Alfredstraße 9D-

22087

Hamburg

Phone: 040 – 2546 2701

Fax: 040 – 2546 2730

Email: saeger.patho@marienkrankenhaus.org

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