Endocrine Abstracts

JOINT3833

Introduction: Pituitary adenomas are classified based on their hormonal secretion, with prolactinomas, somatotropinomas, and corticotropinomas being the most common. However, pituitary adenomas secreting three hormones are extremely rare and often manifest as a complex endocrine syndrome. We report a unique case of a triple-secreting pituitary macroadenoma (GH, PRL, ACTH) in a young woman, presenting solely with isolated galactorrhea, without signs of acromegaly or Cushing’s syndrome.

Case Presentation: A 25-year-old woman presented with a six-year history of bilateral galactorrhea, which later progressed to secondary amenorrhea and thyrotropic insufficiency. She had no headaches, visual disturbances, or symptoms suggestive of acromegaly or hypercortisolism. Clinical examination confirmed bilateral galactorrhea, with no facial dysmorphism, acral enlargement, centripetal obesity, or easy bruising. Laboratory tests revealed hyperprolactinemia (>250 ng/ml, normal: 5-35 ng/ml), a normal IGF-1 level, and a normal 24-hour urinary free cortisol level. Thyroid function tests confirmed central hypothyroidism, with normal gonadotropin levels. Brain MRI revealed a sellar and suprasellar pituitary macroadenoma (25 × 14 × 20 mm) with optic chiasm compression and lateral extension into the cavernous sinuses, exhibiting heterogeneous gadolinium enhancement. Histopathological analysis confirmed a pituitary adenoma with strong immunohistochemical positivity for GH, prolactin, and ACTH, with negative staining for TSH and gonadotropins.

Discussion and Conclusions: Triple-hormone-secreting pituitary adenomas are extremely rare and usually present with overt clinical signs of hormone hypersecretion. However, in this case, the patient exhibited only galactorrhea and secondary amenorrhea, despite histological evidence of GH and ACTH hypersecretion, suggesting silent or subclinical hormonal overproduction. This case highlights the importance of a comprehensive endocrine evaluation, as some patients may develop delayed manifestations. First-line treatment consists of transsphenoidal surgery, aiming to reduce tumor mass and normalize hormone secretion, followed by dopamine agonist therapy for hyperprolactinemia and levothyroxine replacement for thyrotropic insufficiency. Long-term endocrine follow-up is essential to detect potential late-onset acromegaly or Cushing’s syndrome, emphasizing the need for a multidisciplinary approach involving endocrinologists, neurosurgeons, and radiologists to optimize the patient’s prognosis.