Repeated remissions of cushing's disease due to recurrent infarctions of an ACTH-Producing pituitary macroadenoma

被引：16

作者：

Alarifi A. ^{[1
]}

Alzahrani A.S. ^{[1
,3
]}

Salam S.A. ^{[1
]}

Ahmed M. ^{[1
]}

Kanaan I. ^{[2
]}

机构：

[1] Department of Medicine, King Faisal Specialist Hospital and Research Centre

[2] Department of Neurosciences, King Faisal Specialist Hospital and Research Centre

[3] Riyadh 11211

来源：

Pituitary | 2005年 / 8卷 / 2期

关键词：

Adrenal insufficiency; Apoplexy; Cushing's disease;

D O I：

10.1007/s11102-005-2961-8

中图分类号：

学科分类号：

摘要：

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. © 2005 Springer Science + Business Media, Inc.

引用

页码：81 / 87

页数：6

共 27 条

[1]

Mohr G., Hardy J., Hemorrhage, necrosis, and apoplexy in pituitary adenomas, Surg Neurol, 18, pp. 181-189, (1982)

[2]

Wakai S., Fukushima T., Teramoto A., Sano K., Pituitary apoplexy: Its incidence and clinical significance, J Neurosurg, 55, pp. 187-193, (1981)

[3]

Randeva H.S., Schoebel J., Byrne J., Esiri M., Adams C.B., Wass J.A., Classical pituitary apoplexy: Clinical features, management and outcome, Clin Endocrinol, 51, pp. 181-188, (1999)

[4]

Rovit R.L., Fein J.M., Pituitary apoplexy: A review and reappraisal, J Neurosurg, 37, pp. 280-288, (1972)

[5]

Dickstein G., Arad E., Shechner C., Late complications in remission from Gushing disease. Recurrence of tumor with reinfarction or transformation into a silent adenoma, Arch Intern Med, 157, pp. 2377-2380, (1997)

[6]

Onesti S.T., Wisniewski T., Post K.D., Clinical versus subclinical pituitary apoplexy: Presentation, surgical management, and outcome in 21 patients, Neurosurgery, 26, pp. 980-986, (1990)

[7]

Biousse V., Newman N.J., Oyesiku N.M., Precipitating factors in pituitary apoplexy, J Neurol Neurosurg Psychiatry, 71, pp. 542-545, (2001)

[8]

Kamoi K., Toyama M., Sudo N., A case of Cushing's disease revealed six years after postpartum hypopituitarism, J Clin Endocrinol Metab, 84, pp. 2718-2723, (1999)

[9]

Mercado-Asis L.B., Oldfield E.H., Cutler Jr. G.B., Pituitary tumor hemorrhage in Gushing disease, Ann Intern Med, 122, pp. 189-190, (1995)

[10]

Le Nestour E., Abecassis J.P., Bertagna X., Bonnin A., Luton J.P., Silent necrosis of a pituitary corticotroph adenoma revealed by timely magnetic resonance imaging: A cause of spontaneous remission of Cushing's disease, Eur J Endocrinol, 130, pp. 469-471, (1994)

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