Document Detail

Repeated remissions of Cushing's disease due to recurrent infarctions of an ACTH-producing pituitary macroadenoma.
MedLine Citation:
PMID:  16195779     Owner:  NLM     Status:  MEDLINE    
Infarction of prolactin-secreting or growth hormone-secreting pituitary adenomas is not unusual. However, Infarction of ACTH-secreting adenomas has rarely been reported. Cyclical course of Cushing's syndrome alternating with adrenal insufficiency due to recurrent infarction of an ACTH-secreting pituitary adenoma has not been reported. We report here a 20-year-old lady who presented with florid signs of Cushing's syndrome but was found to have adrenal insufficiency on biochemical evaluation. Magnetic resonance imaging (MRI) of the pituitary gland showed that she had infarction of an ACTH-secreting macroadenoma. Over the next 6 years, her disease ran a cyclical course characterized by periods of hypercortisolism alternating with adrenal insufficiency due to repeated episodes of infarctions of the ACTH-secreting pituitary macroadenoma with corresponding changes in the pituitary adenoma on serial MRIs. The case alerts clinicians to this possibility when a patient presents with clinical picture of Cushing's syndrome but has adrenal insufficiency on biochemical testing. It also suggests that silent or subclinical infarction of pituitary adenomas is not uncommon and is probably under diagnosed.
Abdullah Alarifi; Ali S Alzahrani; Suzan Abdel Salam; Mohammed Ahmed; Imaduddin Kanaan
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Pituitary     Volume:  8     ISSN:  1386-341X     ISO Abbreviation:  Pituitary     Publication Date:  2005  
Date Detail:
Created Date:  2006-02-27     Completed Date:  2006-06-23     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9814578     Medline TA:  Pituitary     Country:  United States    
Other Details:
Languages:  eng     Pagination:  81-7     Citation Subset:  IM    
Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, 11211, Saudi Arabia.
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MeSH Terms
Adenoma / blood supply*,  diagnosis,  secretion
Adrenocorticotropic Hormone / secretion*
Infarction / physiopathology*
Magnetic Resonance Imaging
Pituitary ACTH Hypersecretion / diagnosis,  physiopathology*
Pituitary Neoplasms / blood supply*,  diagnosis,  secretion
Remission, Spontaneous
Reg. No./Substance:
9002-60-2/Adrenocorticotropic Hormone

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