title: Addison's Disease and Pituitary Enlargement.
abstract: A 60-year-old man with Addison's disease, primary hypothyroidism and type 2 diabetes mellitus who was treated with stable doses of hydrocortisone and fludrocortisone developed increasing skin pigmentation and a bitemporal hemianopia. The plasma ACTH level was 14,464 pg/mL, and an invasive pituitary macroadenoma with suprasellar extension was found on magnetic resonance imaging leading to transnasal-transsphenoidal adenomectomy. The tumor demonstrated features of an eosinophilic adenoma and stained uniformly for ACTH. Residual tumor was treated with stereotactic radiotherapy. This case and the 13 cases published previously indicate that primary adrenal failure may predispose to corticotroph hyperplasia, and in some patients to the development of an invasive corticotroph adenoma. The ACTH level should be measured, and a pituitary magnetic resonance imaging is indicated when skin pigmentation increases in a patient with primary adrenal failure who is receiving customary treatment with glucocorticoids and mineralocorticoids.
authors.affiliation: Division of Endocrinology, Metabolism and Diabetes (SJW), University of Louisville School of Medicine, Louisville, Kentucky; Department of Radiation Oncology (CS), University of Louisville School of Medicine, Louisville, Kentucky; Brain Tumor Center (TV), Norton Neuroscience Institute; and Departments of Pathology (MRN), Radiology (DCC), Norton Health Care, Louisville, Kentucky.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Winters
authors.forename: Todd
authors.initials: T
authors.lastname: Vitaz
authors.forename: Michael R
authors.initials: MR
authors.lastname: Nowacki
authors.forename: Durrett C
authors.initials: DC
authors.lastname: Craddock
authors.forename: Craig
authors.initials: C
authors.lastname: Silverman
mesh_terms: D000224:Addison Disease / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D005438:Fludrocortisone / Q000008:administration & dosage*; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy; D011859:Radiography
chemical_list: D000893:Anti-Inflammatory Agents; D000324:Adrenocorticotropic Hormone; D005438:Fludrocortisone; D006854:Hydrocortisone