title: Full-blown Cushing's disease after an episode of pituitary apoplexy.
abstract: The present study reports a rare case of full-blown Cushing's disease several years after an episode of pituitary apoplexy. A 60 year-old woman complained of muscular weakness and generalized malaise. Ten years ago she had an episode of pituitary apoplexy. Diabetes mellitus was diagnosed at age 56, and thereafter she had been controlled her plasma glucose with diet therapy and oral hypoglycemic agents. She exhibited cushingoid feature of moon face and central obesity. Both plasma ACTH and serum cortisol levels were elevated to 170 pg/ml and 19.6 microg/dl, respectively. Dexamethasone suppression test showed that a large dose of 8 mg dexamethasone, but not a small dose of 2 mg, suppressed the pituitary-adrenocortical axis. CRH and methyrapone caused increases in plasma ACTH and serum cortisol levels. Brain T(1)-weighted magnetic resonance imaging depicted a low signal of pituitary tumor, which was not enhanced by gadolinium. The pituitary tumor was removed by transsphenoidal adenomectomy, and immunohistochemistry revealed an ACTH-producing adenoma. The evidence suggested the possibility that the two pituitary tumors with dormant period of several years were a recurrence of ACTH-producing tumors in the present patient.
authors: Department of Medicine, Jichi Medical School Omiya Medical Center, Saitama, Japan.
authors: Masami
authors: M
authors: Sasaki
authors: Hiroshi
authors: H
authors: Funayama
authors: Takeharu
authors: T
authors: Asano
authors: Keizo
authors: K
authors: Kasono
authors: Kazuyuki
authors: K
authors: Namai
authors: Hiroyuki
authors: H
authors: Tamemoto
authors: Shinji
authors: S
authors: Ueno
authors: Masahiro
authors: M
authors: Ota
authors: Masanobu
authors: M
authors: Kawakami
authors: Sohji
authors: S
authors: Shinoda
authors: San-E
authors: SE
authors: Ishikawa
mesh_terms: D000236:Adenoma / Q000150:complications / Q000175:diagnosis / Q000378:metabolism / Q000601:surgery; D000284:Administration, Oral; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D003480:Cushing Syndrome / Q000150:complications / Q000209:etiology*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000178:diet therapy / Q000188:drug therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009765:Obesity / Q000150:complications; D010899:Pituitary Apoplexy / Q000150:complications*; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis / Q000378:metabolism / Q000601:surgery
chemical_list: D007004:Hypoglycemic Agents; D000324:Adrenocorticotropic Hormone