title: [Recurrent hypercortisolism after removal of an ACTH secretor pituitary adenoma associated with an adrenal macronodule].
abstract: A 29 years old patient was sent to our Outpatient Clinic of Endocrinology presenting clinic of hypercortisolism. Laboratorial study: High urinary free cortisol (UFC); serum cortisol - 25 microg/dl (8 am) (5-25) and 20 microg/dL (11pm); ACTH - 20 pg/mL (9-52) (8 am) and 14 pg/mL (11 pm); serum cortisol after dexamethasone suppression test: 14,9 mg/dL; CRH test: elevation of ACTH; Pituitary MRI: microadenoma; abdominal CT: nodule on the left adrenal. During inferior petrosal sinus sampling with CRH stimulation, ACTH reached 368 pg/mL on the right and 136 pg/mL on the left side. The patient was submitted to transsphenoidal surgery. After surgery, hypertension and physical stigmata improved. In 2006, a relapse of Cushing syndrome was suspected due to worsening of hypertension and increase of weight. A slight increase of UFC, undetectable ACTH and serum cortisol after dexamethasone suppression test equal to 16 microg/dL were found. On abdominal CT, the adrenal nodule kept the same characteristics. In December 2006, the patient was submitted to left adrenalectomy. After surgery, blood pressure normalized, UFC and serum cortisol were reduced, needing substitutive therapy. Progressive tapering of hydrocortisone doses lead to discontinuation in March 2007. He is clinically well, without any treatment. This is an unusual case, in which after surgical cure of Cushing disease, secretory autonomy of a coexisting adrenal nodule occurred. This clinical case is relevant, pointing out the complexity of hypercortisolism cases and the need of long follow-up.
authors.affiliation: Serviço de Endocrinologia, Diabetes e Metabolismo, Hospitais da Universidade de Coimbra, Coimbra.
authors.forename: Jacinta
authors.initials: J
authors.lastname: Santos
authors.forename: Isabel
authors.initials: I
authors.lastname: Paiva
authors.forename: Leonor
authors.initials: L
authors.lastname: Gomes
authors.forename: Carla
authors.initials: C
authors.lastname: Batista
authors.forename: Elisabete
authors.initials: E
authors.lastname: Geraldes
authors.forename: Manuel
authors.initials: M
authors.lastname: Rito
authors.forename: Ana
authors.initials: A
authors.lastname: Velez
authors.forename: Fernando
authors.initials: F
authors.lastname: Oliveira
authors.forename: Manuela
authors.initials: M
authors.lastname: Carvalheiro
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000150:complications* / Q000601:surgery*; D000236:Adenoma / Q000150:complications* / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000150:complications*; D000328:Adult; D003480:Cushing Syndrome / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D012008:Recurrence