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Double pituitary adenomas with distinct histological features: presentation of an interesting case

Introduction Double pituitary adenomas are rare. The incidence is approximately 1% of autopsy pituitaries and 0.4–2.6% of large surgical series. The growth hormone producing pituitary adenomas are classified as densely granulated type and sparsely granulated type. The latter shows a more aggressive clinical course. Case presentation A 27-year-old Bangladeshi male presented with acromegaly and a high serum IGF-1 (189 nmol/L with a normal range of 15–50 nmol/L). MRI showed a 9 mm hypo-enhancing nodule in his right pituitary consistent with a micro adenoma. During trans-sphenoidal surgery, no macroscopic lesion was found in the right side, however a well demarcated nodule was seen in the left pituitary (not identified on the imaging). This was resected and histologically confirmed as a growth hormone-producing adenoma of sparsely granulated type. Three monthly screening revealed a sustained high serum IGF-1 (142 nmol/L) leading to further investigation and a second operation to resect an encapsulated nodule in the right pituitary with no connection to the left. This lesion was proven to be another growth hormone-producing adenoma of densely granulated type. Discussion Double pituitary adenomas are rare. The distinction between different subtypes of growth hormone producing adenomas can impact on medical therapy and patients’ outcomes.