Consecutive resections of double pituitary adenoma for resolution of Cushing disease: illustrative case. J Neurosurg Case Lessons 2023 Nov 27;6(22)
Date
11/27/2023Pubmed ID
38011690Pubmed Central ID
PMC10684060DOI
10.3171/CASE23485Scopus ID
2-s2.0-85178085217 (requires institutional sign-in at Scopus site)Abstract
BACKGROUND: Double pituitary adenomas are rare presentations of two distinct adenohypophyseal lesions seen in <1% of surgical cases. Increased rates of recurrence or persistence are reported in the resection of Cushing microadenomas and are attributed to the small tumor size and localization difficulties. The authors report a case of surgical treatment failure of Cushing disease because of the presence of a secondary pituitary adenoma.
OBSERVATIONS: A 32-year-old woman with a history of prolactin excess and pituitary lesion presented with oligomenorrhea, weight gain, facial fullness, and hirsutism. Urinary and nighttime salivary cortisol elevation were elevated. Magnetic resonance imaging confirmed a 4-mm3 pituitary lesion. Inferior petrosal sinus sampling was diagnostic for Cushing disease. Primary endoscopic endonasal transsphenoidal resection was performed to remove what was determined to be a lactotroph-secreting tumor on immunohistochemistry with persistent hypercortisolism. Repeat resection yielded a corticotroph-secreting tumor and postoperative hypoadrenalism followed by long-term normalization of the hypothalamic-pituitary-adrenal axis.
LESSONS: This case demonstrates the importance of multidisciplinary management and postoperative hormonal follow-up in patients with Cushing disease. Improved strategies for localization of the active tumor in double pituitary adenomas are essential for primary surgical success and resolution of endocrinopathies.
Author List
Armstrong SA, Tavakoli S, Shah I, Laing BR, Coss D, Ioachimescu AG, Findling J, Zwagerman NTAuthors
James W. Findling MD Professor in the Medicine department at Medical College of WisconsinAdriana G. Ioachimescu MD, PhD Professor in the Medicine department at Medical College of Wisconsin
Nathan Zwagerman MD Associate Professor in the Neurosurgery department at Medical College of Wisconsin
