Nail hyperpigmentation in ACTH-secreting pituitary adenoma (Cushing’s disease) and its resolution after successful trans-sphenoidal excision

Backgraund. Regardless of improvements in MRI, up to 20% of ACTH-secreting pituitary tumors are only identified at surgical exploration.Aim: to estimate whether there is any difference in blood vessels and the subsequent ability to uptake contrast agent in visualized microadenoma as compared to non-visualized on MRI ACTH-secreting pituitary tumors.Materials and methods. retrospective evaluation of ACTH-positive pituitary tumors from patients with Cushing’s disease (n=39) with either non-visualized pituitary tumor on MRI (n=17) or pituitary tumor less then 25 mm (n=22). MRI was performed using Siemens Magnetom Harmony 1.0T with gadolinium. Selected tumors were stained with anty-СD34 antibody (clone QBEnd/10, RTU, Leica) and anty-D2-40 antibody (clone D2-40, RTU, Dako). We evaluated the microvessels density and measured the diameter of larger and smaller vessel.Results. The microvessels density were not different in subject with visualized (123 [77;136]) and non-visualized (112 [110,0;126,5]) pituitary adenomas as well as number of slit-shaped vessels (32 [5;50] in visualized vs 25 [5;50] in non-visualized pituitary adenoma). The diameter of these vessels also did not differ: the diameter of the largest vessels in patients without visualization 53 µm [32,5;63,5] vs 33 µm [30,0;51,5], the average diameter of the blood vessels 15 µm [14,5-26,0] against 13 µm [12;14].Conclusions. The diameter and microvessels density in ACTH-producing pituitary adenoma does not affect the visualization of adenoma on MRI in patients with Cushing 's disease.

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Immunochistochemical characteristics of blood vessels in non-visualized and visualized on MRI pituitary adenoma in patients with Cushing’s disease

Problems of Endocrinology ◽

10.14341/probl201662411-17 ◽

2016 ◽

Vol 62 (4) ◽

pp. 11-17

Author(s):

Patimat M. Khandaeva ◽

Ija А. Voronkova ◽

Zhanna E. Belaya ◽

Ljudmila Ya. Rozhinskaya ◽

Aleksandr V. Vorontsov ◽

...

Keyword(s):

Pituitary Adenoma ◽

Blood Vessels ◽

Cushing’S Disease ◽

Pituitary Tumor ◽

Pituitary Tumors ◽

Average Diameter ◽

Cushing's Disease ◽

Retrospective Evaluation ◽

Acth Secreting ◽

Microvessels Density

Background. Regardless of improvements in MRI, up to 20% of ACTH-secreting pituitary tumors are only identified at surgical exploration. Aim. Тo estimate whether there is any difference in blood vessels and the subsequent ability to uptake contrast agent in visualized microadenoma as compared to non-visualized on MRI ACTH-secreting pituitary tumors.Material and methods. Retrospective evaluation of ACTH-positive pituitary tumors from patients with Cushing’s disease (n=39) with either non-visualized pituitary tumor on MRI (n=17) or pituitary tumor less then 25 mm (n=22). MRI was performed using Siemens Magnetom Harmony 1.0T with gadolinium. Selected tumors were stained with anty-СD34 antibody (clone QBEnd/10, RTU, Leica) and anty-D2-40 antibody (clone D2-40, RTU, Dako). We evaluated the microvessels density and measured the diameter of larger and smaller vessel.Results. The microvessels density were not different in subject with visualized [123 (77; 136)] and non-visualized [112 (110,0; 126,5)] pituitary adenomas as well as number of slit-shaped vessels [32 (5; 50) in visualized vs 25 (5; 50) in non-visualized pituitary adenoma]. The diameter of these vessels also did not differ: the diameter of the largest vessels in patients without visualization 53 µm (32,5; 63,5) vs 33 µm (30,0; 51,5) the average diameter of the blood vessels 15 µm (14,5—26,0) against 13 µm (12; 14).Conclusions. The diameter and microvessels density in ACTH-producing pituitary adenoma does not affect the visualization of adenoma on MRI in patients with Cushing ‘s disease.

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Successful long-term control of Cushing’s disease after partial resection of gigantic ACTH-secreting pituitary adenoma

Endocrine Oncology and Metabolism ◽

10.21040/eom/2016.2.10 ◽

2016 ◽

Vol 2 (1) ◽

pp. 88-93

Author(s):

Vatroslav Čerina ◽

◽

Luigi Cavallo ◽

Ivan Kruljac ◽

Jelena Marinković Radošević ◽

...

Keyword(s):

Pituitary Adenoma ◽

Cushing’S Disease ◽

Partial Resection ◽

Cushing's Disease ◽

Acth Secreting

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A Woman with Weight Gain and Fatigue

10.1093/med/9780190609917.003.0011 ◽

2017 ◽

Author(s):

Alexandra Lovett ◽

Whitney W. Woodmansee

Keyword(s):

Pituitary Adenoma ◽

Cushing’S Disease ◽

Dexamethasone Suppression Test ◽

Cushing's Disease ◽

Distal Muscle ◽

Suppression Test ◽

Urine Cortisol ◽

Acth Secreting ◽

Dexamethasone Suppression ◽

Transsphenoidal Resection

Cushing’s syndrome is a descriptive term of a syndrome secondary to elevated levels of steroids or cortisol, while Cushing’s disease is hypercortisolemia that results from an adrenocorticotropic (ACTH)-secreting pituitary adenoma. Patients will present with cushingoid features on physical examination and can be myopathic with proximal rather than distal muscle weakness. Diagnosis can be obtained by multiple avenues including but not limited to checking 24 hour urine cortisol, a dexamethasone suppression test, checking ACTH levels, a CRH (corticotrophin-releasing hormone) stimulation test, and inferior petrosal sinus sampling (IPSS). Once Cushing’s disease is confirmed, treatment is via transsphenoidal resection of the pituitary adenoma.

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Systemic Sarcoidosis Unmasked by Cushing’s Disease Surgical Treatment

Case Reports in Medicine ◽

10.1155/2016/6405840 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Daniele Bongetta ◽

Cesare Zoia ◽

Francesco Lombardi ◽

Elisabetta Lovati ◽

Pietro Lucotti ◽

...

Keyword(s):

Surgical Treatment ◽

Pituitary Adenoma ◽

Cushing’S Syndrome ◽

Cushing’S Disease ◽

Cushing's Syndrome ◽

Cushing's Disease ◽

Systemic Sarcoidosis ◽

Acth Secreting ◽

Possible Cause

Diseases responsive to glucocorticoids, like sarcoidosis, are rarely masked by Cushing’s syndrome. An ACTH secreting pituitary adenoma is a possible cause of Cushing’s syndrome and its resection can make a subclinical sarcoidosis clear. Only few cases of sarcoidosis following the treatment of hypercortisolism are reported in literature. We report a case of sarcoidosis after the resection of an ACTH secreting pituitary adenoma.

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Progression of an Invasive ACTH Pituitary Macroadenoma with Cushing’s Disease to Pituitary Carcinoma

Case Reports in Oncological Medicine ◽

10.1155/2015/810367 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Clarissa Groberio Borba ◽

Rafael Loch Batista ◽

Nina Rosa de Castro Musolino ◽

Vanielle Carvalho Machado ◽

Ana Elisa Evangelista Alcantara ◽

...

Keyword(s):

Pituitary Adenoma ◽

Cushing’S Disease ◽

Adrenocorticotropic Hormone ◽

Pituitary Carcinoma ◽

Cushing's Disease ◽

Resonance Imaging ◽

Ki 67 ◽

P53 Expression ◽

Acth Secreting ◽

Pituitary Carcinomas

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.

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Cushing's Disease in a Young Woman with Anorexia Nervosa: Pathophysiological Implications

The Canadian Journal of Psychiatry ◽

10.1177/070674378603100915 ◽

1986 ◽

Vol 31 (9) ◽

pp. 861-864 ◽

Cited By ~ 4

Author(s):

Jack L. Katz ◽

Herbert Weiner ◽

Jacob Kream ◽

Barnett Zumoff

Keyword(s):

Anorexia Nervosa ◽

Pituitary Adenoma ◽

Young Woman ◽

Cushing’S Syndrome ◽

Cushing’S Disease ◽

Adrenal Glands ◽

Cushing's Syndrome ◽

Cushing's Disease ◽

Sequence Of Events ◽

Acth Secreting

This report describes a 17-year old student who was found to have Cushing's syndrome two years after she had developed anorexia nervosa (AN). The Cushing's syndrome was treated with bilateral resection of enlarged, hyperplastic, non-tumoraus adrenal glands. The diagnosis was further confirmed four years later when, two to three years after new symptoms had appeared, an ACTH secreting pituitary adenoma (that is, Cushing's disease) was found on surgery. The possible mechanism for the development of Cushing's disease in a patient with prior anorexia nervosa, a sequence of events reported once previously, is discussed. It is suggested that increased hypothalamić-pituitary corticotroph stimulation in association with the anorexia nervosa, a now well-established endocrine phenomenon, activated an occult, inactive pituitary basophil adenoma in this patient, eventually resulting in autonomous pituitary overproduction of ACTH by the tumor.

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Case report: ACTH-secreting pituitary carcinoma metastatic to the liver in a patient with a history of atypical pituitary adenoma and Cushing’s disease

Diagnostic Pathology ◽

10.1186/s13000-017-0624-5 ◽

2017 ◽

Vol 12 (1) ◽

Cited By ~ 2

Author(s):

Amy S. Joehlin-Price ◽

Douglas A. Hardesty ◽

Christina A. Arnold ◽

Lawrence S. Kirschner ◽

Daniel M. Prevedello ◽

...

Keyword(s):

Case Report ◽

Pituitary Adenoma ◽

Cushing’S Disease ◽

Pituitary Carcinoma ◽

Cushing's Disease ◽

History Of ◽

Atypical Pituitary Adenoma ◽

Acth Secreting

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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.

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ICA Occlusion by an ACTH- secreting pituitary adenoma post-TSS and irradiation

McGill Journal of Medicine ◽

10.26443/mjm.v13i1.240 ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Diala El-Zammar ◽

Ryojo Akagami

Keyword(s):

Pituitary Adenoma ◽

Cushing’S Disease ◽

Pituitary Tumour ◽

Cushing's Disease ◽

Suppressive Therapy ◽

Pathological Examination ◽

Pituitary Macroadenoma ◽

The Right ◽

Acth Secreting

Occlusion of intracranial arteries by a pituitary adenoma with ensuing infarction is a rare occurrence. In this case study, we show the instance of a pituitary macroadenoma and apoplexy causing mechanical obstruction of the internal carot- id artery with consequent infarction following transphenoidal surgery (TSS) and ra- diation therapy in a patient with Cushing’s disease. we report a 44-year-old woman presented with amenorrhea and headaches. Necessary investigations, resection by TSS, and microscopic examination revealed an adenocorticotropin (ACTH)-secret- ing pituitary macroadenoma. The pituitary tumour recurred in subsequent years, resulting in the development of Cushing’s disease and syndrome. despite two more transphenoidal surgeries, radiotherapy, and medical suppressive therapy, the pi- tuitary adenoma continued to enlarge, and the hypercortisolemia and Cushingoid symptoms persisted. A craniotomy was arranged as the next step in the treatment strategy. Only hours prior to the scheduled surgery, the patient developed left-sided hemiplegia, was diagnosed with acute occlusion of the right ICA and underwent an emergency bifrontal craniotomy with evacuation of the tumour and decompression. Pathological examination revealed evidence of apoplexy in the ACTH-secreting pi- tuitary adenoma. This case demonstrates the vast scope of complications that can arise from pituitary adenomas despite combination therapy and forewarns clinicians to be prepared to manage these infrequent but conceivable occurrences.

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