Silent pituitary apoplexy: subclinical infarction of an adrenocorticotropin-producing pituitary adenoma.
A young woman developed intermittent headaches and progressive hyperpigmentation after bilateral adrenalectomy for Cushing's disease. Results of sellar polytomography were abnormal. Her plasma ACTH levels increased to 4750-7340 pg/ml and did not rise with insulin-induced hypoglycemia. Although she experienced no clinical features associated with spontaneous infarction of a pituitary tumor, plasma ACTH levels fell to 474-575 pg/ml, and hemorrhagic necrosis was found in a 5-mm chromophobe adenoma at transsphenoidal surgery. Postoperatively, ACTH levels returned to normal (51-88 pg/ml), with the rest of her anterior pituitary function remaining intact 4 yr later. Spontaneous infarction of pituitary microadenomas may be subclinical, resulting in improvement of pituitary hormone hypersecretion without impairment of other anterior pituitary hormone secretion.
D000238:Adenoma, Chromophobe / Q000098:blood supply*; D000315:Adrenalectomy; D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000378:metabolism*; D000328:Adult; D005260:Female; D006801:Humans; D007238:Infarction / Q000097:blood*; D007700:Kinetics; D009347:Nelson Syndrome / Q000097:blood / Q000601:surgery; D010911:Pituitary Neoplasms / Q000098:blood supply*
D000324:Adrenocorticotropic Hormone