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ACTH-producing remnants following apoplexy of an ACTH-secreting pituitary macroadenoma.
MedLine Citation:
PMID:  20703943     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Describe a case of apoplexy of an ACTH-producing pituitary adenoma which resulted not only in an empty sella with concurrent hypothyroidism, hypoprolactinemia, and hypogonadism but persistent hypercortisolemia from two distinct extrasellar remnants of the original adenoma. Review the literature to identify other similar cases. The patient's medical history, physical exam, lab data, imaging exams and histopathological results were analyzed and compiled into a case report, and an extensive review of the literature was performed. Endocrinological data revealed hypercortisolism and an elevated ACTH with an otherwise suppressed pituitary axis. A pituitary MRI showed a macroadenoma in the left cavernous sinus in addition to an empty sella. An octreotide scan revealed lesions in the left sella turcica and the right sphenoid sinus. Tissue samples of both lesions stained positive for ACTH and negative for GH, prolactin, FSH, LH, and TSH. The lesions were surgically removed, and the patient treated with radiation and ketoconazole. This resulted in a significant decrease in ACTH and cortisol as well as a marked improvement in blood glucose control. The review of literature revealed the absence of any similar cases in the past. The patient presented with apoplexy of an ACTH-secreting pituitary macroadenoma with two hormonally active extrasellar remnants. Several cases in the literature describe recurrence of Cushing's disease following infarction of ACTH-secreting adenomas. This is the first documented case of infarction of an ACTH-producing adenoma resulting in two distinct ACTH-producing remnants without recurrence of the original adenoma.
Authors:
Caroline Korsten Messer; Mary E Fowkes; J Lester Gabrilove; Kalmon D Post; Honju Son; Alice C Levine
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pituitary     Volume:  15 Suppl 1     ISSN:  1573-7403     ISO Abbreviation:  Pituitary     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9814578     Medline TA:  Pituitary     Country:  United States    
Other Details:
Languages:  eng     Pagination:  6-9     Citation Subset:  IM    
Affiliation:
Department of Endocrinology, Mount Kisco Medical Group, 90 South Bedford Road, Mount Kisco, NY, 10549, USA, ckmesser@gmail.com.
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