Full-blown Cushing's disease after an episode of pituitary apoplexy.
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.
Sasaki
Masami
M
Department of Medicine, Jichi Medical School Omiya Medical Center, Saitama, Japan.
Funayama
Hiroshi
H
Asano
Takeharu
T
Kasono
Keizo
K
Namai
Kazuyuki
K
Tamemoto
Hiroyuki
H
Ueno
Shinji
S
Ota
Masahiro
M
Kawakami
Masanobu
M
Shinoda
Sohji
S
Ishikawa
San-E
SE
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
D007004:Hypoglycemic Agents; D000324:Adrenocorticotropic Hormone