title: Pituitary apoplexy induced by corticotrophin-releasing hormone in a patient with Cushing's disease.
abstract: Pituitary apoplexy can occur spontaneously or following anterior pituitary stimulation tests. Apoplexy is a rare complication of Cushing's disease. We report a 19-year-old woman who was admitted to the National Institutes of Health for evaluation of possible Cushing's syndrome. Her symptoms and initial laboratory work were suggestive of Cushing's disease. Magnetic resonance imaging (MRI) revealed a macroadenoma of the pituitary gland. As part of her evaluation she received corticotrophin-releasing hormone (CRH). Two days later she developed severe headache, accompanied by nausea and vomiting, followed by meningismus, ptosis and diplopia. A diagnosis of pituitary apoplexy was made and she was treated conservatively with dexamethasone. Her neurological symptoms resolved shortly afterwards. By the time of discharge her anterior pituitary function was suppressed. All symptoms and signs of Cushing's syndrome resolved thereafter. This is the first case to demonstrate that CRH administration can induce pituitary apoplexy in a patient with Cushing's disease. Therapy with glucocorticoids was effective in our case, suggesting that conservative treatment can be successfully and safely applied in certain cases with pituitary apoplexy.
authors.affiliation: Clinical Endocrinology Branch, National Institute of Diabetes Digestive and Kidney Diseases, NIH, Bethesda, MD, USA.
authors.forename: Pnina
authors.initials: P
authors.lastname: Rotman-Pikielny
authors.forename: Nicholas
authors.initials: N
authors.lastname: Patronas
authors.forename: Dimitris A
authors.initials: DA
authors.lastname: Papanicolaou
mesh_terms: D000236:Adenoma / Q000175:diagnosis; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003346:Corticotropin-Releasing Hormone / Q000009:adverse effects* / Q000502:physiology; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010899:Pituitary Apoplexy / Q000139:chemically induced* / Q000188:drug therapy / Q000503:physiopathology; D010901:Pituitary Function Tests / Q000009:adverse effects; D010903:Pituitary Gland, Anterior / Q000503:physiopathology; D010911:Pituitary Neoplasms / Q000175:diagnosis
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone