A Case of Cushing’s Disease Caused by Pituitary Adenoma Producing Adrenocorticotropic Hormone and Growth Hormone Concomitantly: Aberrant Expression of Transcription Factors NeuroD1 and Pit-1 as a Proposed Mechanism

Pituitary carcinomas are very rare tumors that in most cases produce prolactin and adrenocorticotropic hormone (ACTH). It is a challenge to diagnosis of a pituitary carcinoma before disclosed symptomatic metastasis. We report the case of a female patient with Cushing’s disease who underwent three transsphenoidal surgeries, with pathological findings of common ACTH pituitary adenoma including Ki-67 expression <3%. She achieved hypocortisolism after the 3rd surgery although ACTH levels remained slightly elevated. The patient returned some time later with fast worsening of hypercortisolism. Magnetic resonance imaging showed clivus invasion, which led to a fourth surgery and radiation. This time, immunohistochemistry revealed strong Ki-67 (10% to 15%) and p53 expression. Liver and lumbar spine metastases were found on workup. The patient died after few months due to lung infection. Pituitary carcinomas are rare, and the transformation of an ACTH-secreting pituitary adenoma into a carcinoma is exceptional. The difficulty of defining markers for the diagnosis of carcinoma, before metastasis diagnosis, in order to change the management of the disease, is a challenge.

Download Full-text

Metabolic, Cardiovascular, and Cerebrovascular Outcomes in Growth Hormone-Deficient Subjects with Previous Cushing's Disease or Non-Functioning Pituitary Adenoma

Yearbook of Endocrinology ◽

10.1016/j.yend.2011.06.074 ◽

2011 ◽

Vol 2011 ◽

pp. 305-306

Author(s):

W.H. Ludlam

Keyword(s):

Growth Hormone ◽

Pituitary Adenoma ◽

Cushing’S Disease ◽

Cushing's Disease

Download Full-text

Cushing's disease: pathobiology, diagnosis, and management

Journal of Neurosurgery ◽

10.3171/2016.1.jns152119 ◽

2017 ◽

Vol 126 (2) ◽

pp. 404-417 ◽

Cited By ~ 46

Author(s):

Russell R. Lonser ◽

Lynnette Nieman ◽

Edward H. Oldfield

Keyword(s):

Pituitary Adenoma ◽

Cushing’S Disease ◽

Adrenocorticotropic Hormone ◽

Adrenal Glands ◽

Early Death ◽

Diagnostic Methods ◽

Cushing's Disease ◽

Biochemical Remission ◽

Excessive Secretion ◽

Acth Secreting

Cushing's disease (CD) is the result of excess secretion of adrenocorticotropic hormone (ACTH) by a benign monoclonal pituitary adenoma. The excessive secretion of ACTH stimulates secretion of cortisol by the adrenal glands, resulting in supraphysiological levels of circulating cortisol. The pathophysiological levels of cortisol are associated with hypertension, diabetes, obesity, and early death. Successful resection of the CD-associated ACTH-secreting pituitary adenoma is the treatment of choice and results in immediate biochemical remission with preservation of pituitary function. Accurate and early identification of CD is critical for effective surgical management and optimal prognosis. The authors review the current pathophysiological principles, diagnostic methods, and management of CD.

Download Full-text

Development of Pseudotumor Cerebri after the Removal of an Adrenocorticotropic Hormone-secreting Pituitary Adenoma

Neurosurgery ◽

10.1227/00006123-198106000-00011 ◽

1981 ◽

Vol 8 (6) ◽

pp. 699-702 ◽

Cited By ~ 11

Author(s):

Neil A. Martin ◽

John Linfoot ◽

Charles B. Wilson

Keyword(s):

Pituitary Adenoma ◽

Cushing’S Disease ◽

Adrenocorticotropic Hormone ◽

Pseudotumor Cerebri ◽

Cushing's Disease ◽

Elevated Intracranial Pressure ◽

Potential Complication ◽

Computed Tomographic ◽

Appropriate Treatment ◽

Computed Tomographic Scan

abstract A patient with Cushing's disease developed intracranial hypertension 1 month after the removal of an adrenocorticotropic hormone-secreting pituitary adenoma. A computed tomographic scan demonstrated normal ventricles and no intracranial mass, establishing the diagnosis of pseudotumor cerebri. The elevated intracranial pressure was apparently consequent to an abrupt reduction in circulating corticosteroids. The development of pseudotumor cerebri after the correction of endogenous hypercortisolism has not been reported previously. This potential complication of the surgical treatment of Cushing's disease can be managed with prompt recognition and appropriate treatment of the syndrome.

Download Full-text