A patient with acromegaly was found to have a discrete adenoma of the pharyngeal pituitary lodged within the sphenoid sinus. Removal of this adenoma, believed to be complete, did not normalize the growth hormone secretion. At the time of surgery, inspection and biopsy of the pituitary gland failed to disclose the presence of any identifiable intrasellar adenoma; one year later, however, definite radiological changes indicated the presence of an intrasellar mass. The underlying pathophysiology in this patient may have been due to diffuse hyperplasia of hypersecreting nonsuppressible somatotrophs, with adenoma formation secondary to the hyperplasia.
(JAMA 243:1456-1457, 1980)