case_images: PMC10985640_01
case_images: Clinical course after the appearance of diplopia. (a) Contrast-enhanced magnetic resonance imaging of pituitary tumors. (b) The solid line indicates the ACTH level. ACTH, adrenocorticotropic hormone.
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case_images: PMC10985640_01_CRIE2024-8721614.001.jpg
case_images: fig1
case_images: Pituitary contrast-enhanced magnetic resonance imaging (MRI) revealed a 25 x 20 x 20-mm-sized macroadenoma with a poor contrast effect from the sella turcica to the suprasellar region, and the normal pituitary gland was compressed cephalad to the lesion (Figure 1(a)). Hydrocortisone replacement was terminated 10 days after surgery (Figure 1(b)).
case_images: The results of preoperative and postoperative CRH loading tests. The dotted line on the (a) represents the ACTH level. The solid line on the (b) illustrates the cortisol levels. ACTH, adrenocorticotropic hormone.
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case_images: PMC10985640_01_CRIE2024-8721614.002.jpg
case_images: fig2
case_images: The corticotropin-releasing hormone (CRH) (100 mug) test showed that the plasma ACTH level was 1.5 times higher than the preload value (Figure 2). In the postoperative CRH test (100 mug), plasma ACTH levels showed a six-fold increase (Figure 2). Plasma cortisol levels increased during the preoperative CRH test (Figure 2).
case_images: Immunostaining of excised pituitary adenomas. The upper figure represents hematoxylin-eosin staining, and the lower figure represents ACTH staining. H&E, hematoxylin-eosin staining; ACTH, adrenocorticotropic hormone.
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case_images: PMC10985640_01_CRIE2024-8721614.003.jpg
case_images: fig3
case_images: The tumor specimen showed monotonous cell proliferation with eosinophilic spores and was ACTH-positive on immunostaining (Figure 3).
case_images: Pre- and postoperative ACTH sample fraction assay after gel filtration. The above figure represents ACTH (1-39), and the figure below represents pre- and postoperative ACTH samples fractionated by gel filtration, separated by time, and measured. The solid lines represent preoperative data, and the dotted lines represent postoperative data. (a) 25-min values; (b) 34-min values. ACTH, adrenocorticotropic hormone.
case_images: CRIE2024-8721614.004.jpg
case_images: PMC10985640_01_CRIE2024-8721614.004.jpg
case_images: fig4
case_images: Tokyo, Japan) using AIA-CL automated immunoassay analyzers (Tosoh Corporation, Tokyo, Japan). As a control, a fraction assay in which the ACTH (1-39) standard was treated by gel filtration in the same manner was also performed. ACTH measurement revealed that plasma before surgery showed that in addition to the ACTH (1-39) peak observed at approximately 44 min, high molecular weight fractions were detected at approximately 25 and 34 min (Figure 4). These high molecular weight peaks decreased after surgery.