Recurrence of Cushing's disease 10 years after transsphenoidal adenomectomy: report of a case.
OBJECTIVE
To report a case of recurrent Cushing's disease after an apparent cure and long-term surveillance.


METHODS
We describe in detail the follow-up course of a woman who underwent transsphenoidal resection of a corticotropin-secreting pituitary microadenoma in 1981.


RESULTS
For 2 years postoperatively, the patient exhibited adrenocortical insufficiency. In 1983, the pituitary-adrenal axis was normal. She remained eucorticoid until May 1992, when features of Cushing's syndrome redeveloped. Plasma and urine cortisol and plasma corticotropin levels were once again increased in conjunction with a loss of diurnal variation and abnormal responses to dexamethasone suppression. A magnetic resonance imaging scan of the pituitary gland was consistent with a small lesion on the left side, and petrosal sinus sampling after ovine corticotropin-releasing hormone stimulation was consistent with increased activity on the right side.


CONCLUSIONS
This 10-year interval between apparent cure and recurrence appears to be the longest thus far reported for a patient with Cushing's disease. These observations reinforce the impression that permanent cure of this disorder is uncertain and indicate the need for indefinite follow-up.
Yeboah
A S
AS
Department of Medicine, Roger Williams Medical Center and Brown University School of Medicine, Providence, Rhode Island 02908, USA.
Tucci
J R
JR