Cure of Cushing's disease by transsphenoidal removal of a microadenoma from a pituitary gland despite a radiographically normal sella turcica.
A 37-year-old woman had symptoms of Cushing's disease for two years. Galactorrhea was present. The diagnosis was confirmed by finding intermittently elevated urinary 17-hydroxysteroids, absent circadian rhythm, and elevated plasma ACTH. Plasma prolactin was slightly elevated. Films of the sella turcica were normal. A 9 mm basophilic microadenoma was removed by the transphenoidal approach. Immunocytochemical and electron-microscopic studies showed that the tumor was composed exclusively of ACTH secreting cells. Endocrine re-evaluation one year later revealed normal adrenal function. Serum prolactin had returned to normal. This case provides further evidence that Cushing's disease can be caused by a pituitary microadenoma insufficient in size to deform the sella.
D000237:Adenoma, Basophil / Q000473:pathology / Q000601:surgery*; D000328:Adult; D003480:Cushing Syndrome / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003907:Dexamethasone; D005260:Female; D006801:Humans; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D011388:Prolactin / Q000097:blood; D011859:Radiography; D012658:Sella Turcica / Q000000981:diagnostic imaging
D003907:Dexamethasone; D011388:Prolactin