title: Reduction of a pancreatic tumor after total removal of an ACTH secreting pituitary tumor: differential diagnosis of Cushing's syndrome.
abstract: Endocrinologic tests sometimes fail to distinguish adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma from ectopic ACTH-secreting tumor. The authors experienced a case of Cushing's disease associated with a pancreatic tumor. Venous sampling contributed to the final diagnosis of Cushing's disease in this complex case, while endocrinologic tests showed paradoxical results. A 54-year-old woman presented with Cushing's syndrome and pancreatic tumor. Magnetic resonance imaging (MRI) failed to reveal a pituitary tumor, but a gadolinium-enhanced tumor with cystic components was seen in the pancreatic tail. Results of conventional endocrinologic tests suggested ectopic ACTH syndrome, but venous sampling including cavernous sinus sampling indicated an ACTH-secreting pituitary adenoma. Transsphenoidal surgery revealed a pituitary microadenoma, and total removal of the tumor was achieved. Postoperative abdominal MRI revealed that the pancreatic tumor diminished gradually without treatment. Selective cavernous sinus sampling was useful for distinguishing ACTH-secreting pituitary adenoma from ectopic ACTH syndrome in this complex case. This was a rare case in which the pancreatic tumor diminished after total removal of the ACTH-secreting pituitary adenoma.
authors.affiliation: Department of Neurosurgery, Osaka University Graduate School of Medicine, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Hashiba
authors.forename: Youichi
authors.initials: Y
authors.lastname: Saitoh
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Asanuma
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kouhara
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Maruo
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Fujinaka
authors.forename: Soji
authors.initials: S
authors.lastname: Kasayama
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yoshimine
mesh_terms: D000182:ACTH Syndrome, Ectopic / Q000175:diagnosis; D000236:Adenoma / Q000378:metabolism / Q000601:surgery; D000324:Adrenocorticotropic Hormone / Q000378:metabolism*; D003480:Cushing Syndrome / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications*; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis; D010911:Pituitary Neoplasms / Q000378:metabolism* / Q000601:surgery; D049268:Positron-Emission Tomography
chemical_list: D000324:Adrenocorticotropic Hormone