Failure of clinical remission after transsphenoidal removal of a microadenoma in a patient with Cushing's disease: multiple hyperplastic and adenomatous cell nets in surrounding pituitary tissue.
A patient with Cushing's disease is described who underwent transsphenoidal adenomectomy of a basophilic microadenoma with a diameter of 3 mm. In a piece of surrounding normal pituitary tissue removed at operation, multiple small nests of adenomatous basophilic cells were found both in the adeno- and neurohypophysis. No clinical improvement was observed. Cortisol secretory rate, plasma ACTH, the absent response of plasma cortisol to insulin-induced hypoglycemia, and the responses of plasma cortisol to lysine vasopressin and TRH remained unchanged. The observations in this patient point to the presence of multiple ACTH-secreting adenomatous cell nests and microadenomas throughout pituitary gland and bring back into view the concept of primary stimulation of hypothalamic corticotropin-releasing factor as the primary derangement in some patients with Cushing's disease.
D000236:Adenoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000328:Adult; D003480:Cushing Syndrome / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D006965:Hyperplasia; D010902:Pituitary Gland / Q000473:pathology; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery