Woman 75-year-old treated 30 years for syndrome of acromegaly refused pituitary surgery and irradiation. Five
years and nine months before death she had a colon carcinoma successfully removed. Multinodular hyperfunctional
goitre was treated with carbimazole. For six last years of life corticosteroids were given as a replacement therapy.
Her cause of death was the heart failure due to acromegalic heart disease. In autopsy a large intrasellar and extrasellar
pituitary adenoma without rests of nonneoplastic tissue was found. Nevertheless the target peripheral endocrine
glands except ovaries, were not atrophic. A multinodular goitre and diffuse adrenocortical hyperplasia were revealed.
Histology, and immunohistochemistry demonstrated that mot neoplastic cells were producing GH and ACTH,
dispersly Prl, scattered cells were positive for b-subunit of FSH, LH, TSH. Electron microscopy proved most of the
cells to be densely granulated. We classify the adenoma according to the newly proposed WHO pituitary tumours
classification (1) as plurihormonal, hyperfunctional, extrasellar, typical adenoma from densely granulated cells. We
conclude that in plurihormonal adenomas with dominant (in the case referred acromegalic) symptomatology the
additional hormonal production should be monitored as a possible source of important complications.
pituitary, acromegaly, plurihormonal adenoma.