PMC4228498_01
MR imaging. (a) Pre-operative from 5/1999. (b) Recurrent adenoma, 2008. (c) MRI s/p endoscopic endonasal approach (2nd operation), 2009. (d) Recent MRI, 12/2012
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F1
The patient had an insulin-like growth factor-1 (IGF-1) level of 182 and a serum growth hormone (GH) level of 7.2 following stimulation with L-3,4-dihydroxyphenylalanine (L-DOPA; upper and lower limits 5 ng/ml and 10 ng/ml, respectively.) Imaging revealed a large sellar enhancing lesion with lateral extension [Figure 1].
PMC4228498_02
Growth chart. (a) Stature with age. (b) Weight with age. The CDC growth chart for males (age 2-20) is indicated by percentile. Percentiles are indicated as P where P3 represents the third percentile and so forth
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F2
His growth trajectory had jumped several percentiles in this range, both in height and weight (Refer to Figure 2).
Non-functioning adenoma and recurrent, functioning adenoma. (a) Histological examination from the first resection showed sheets of a uniform population of neoplastic cells with loss of the normal adenohypophysis architecture, x200. (b) Several cells stained positive for GH immunohistochemistry (sparse granulation), 200x. Second resection after 9 years showed similar histological features HandE, x200 (c) and a more diffuse positivity for GH immunohistochemistry (dense granulation), x200 (d)
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F3
Figure 3 demonstrates the patient's pathological specimen.
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