Long-term remission of cyclic Cushing's disease that was diagnosed and treated surgically in non-active phase.
Cyclic Cushing's disease is a rare clinical entity that is defined as a periodic excessive production of adrenocorticotropic hormone (ACTH) and cortisol. Only 42 cases with cyclic Cushing's disease have been reported in the literature. The diagnosis is very difficult because of the fluctuating secretion of ACTH and cortisol. We report a 78-year-old woman with a pituitary adenoma presenting with cyclic Cushing's disease. In the present case, several interesting issues are pointed out: 1) MRI study detected the presence of an adenoma and selective venous sampling in the cavernous sinus disclosed the hypersecretion of ACTH from a pituitary adenoma. These neuroimaging and endocrinological studies were helpful for the diagnosis, even in the remission phase. 2) The disease was in the long-term remission phase after transsphenoidal surgery despite the high recurrence rate in this clinical entity, although it recurred four years later. Even in the remission phase of cyclic Cushing's disease, meticulous endocrinological and neuroimaging examinations can reveal the presence of a pituitary adenoma, which should be treated surgically.
Asano
Shuichiro
S
Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara City, Japan.
Ooka
Hikaru
H
Okazaki
Ryo
R
Ishikawa
Toshio
T
Ochiai
Hiromi
H
Nakashima
Michi
M
Ide
Fuyuaki
F
Hasegawa
Isao
I
Miyawaki
Satoru
S
Nakaguchi
Hiroshi
H
Murakami
Mineko
M
Ogino
Yoshio
Y
Takano
Koji
K
Matsuno
Akira
A
D049913:ACTH-Secreting Pituitary Adenoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000368:Aged; D018450:Disease Progression; D005260:Female; D006801:Humans; D010507:Periodicity; D047748:Pituitary ACTH Hypersecretion / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D012074:Remission Induction; D013997:Time Factors
D000324:Adrenocorticotropic Hormone