Abstract
Silent pituitary adenomas occur in 25–40% of all clinically apparent pituitary tumours. However, the subsequent development of florid Cushing's disease in a patient with a previous non-functioning tumour is extremely rare. We describe a 47 year-old woman presenting initially with a large, invasive and recurrent, non-functioning pituitary tumour. Histopathologic study of the initial tissue did not stain for any hormones. Six years after the initial presentation, she manifested florid ACTH dependent Cushing's syndrome. A recurrent invasive pituitary macroadenoma necessitated a third transphenoidal surgery. The resected specimen, in this instance, revealed positive staining for ACTH, FSH, prolactin, and growth hormone on immunocytochemistry. An incomplete response to surgical, radiation and medical therapy necessitated a bilateral adrenalectomy to control the hypercortisolism, which resulted in remarkable clinical improvement. We also review five previous case reports from the revision literature of similar transformations from non-secreting pituitary adenomas to Cushing's disease. This subset of patients may represent yet another entity in the widening spectrum of Cushing's syndrome.
Similar content being viewed by others
References
Challa VR, Marshall RB, Hopkins MB, Kelly DL Jr, Civantos F. Pathobiologic study of pituitary tumors: report of 62 cases with a review of the recent literature. Hum Pathol 1985;16:873–884.
Bonner RA, Mukai K, Oppeinheimer JH. Two unusual variants of Nelson's syndrome. J Clin Endocrinol Metab 1979; 49:23–29.
Vaughan NJA, Laroche CM, Goodman I, Davies MJ, Jenkins JS. Pituitary Cushing's disease arising from a previously non-functional corticotropic chromophobe adenoma. Clin Endocrinol 1985;22:147–153.
Cooper ME, Murray RML, Kalnins R, Woodward J, Jerums G. The development of Cushing's syndrome from a previously silent pituitary tumor. Aust NZ J Med 1987;17: 249–251.
Gogel EL, Salber PR, Tyrrell JB, Rosenblum ML, Findling JW. Cushing's disease in a patient with a non-functioning pituitary tumor-spontaneous development and remission. Arch Intern Med 1983;143:1040–1042.
Gheri RG, Boddi W, Ammannati F, Olivotto J, Nozzoli C, Franchi A, Bordi L, Luisi MLE, Mennonna P. Two-step development of a pituitary adenoma: from hyperprolactinaemic syndrome to Cushing's disease. J Endocrinol Invest 1997;20:240–244.
Klibanski A. Non-secreting pituitary tumors. Endocrinol Metab Clin North Am 1987;16:793–804.
Saeger W, Geisler F, Ludecke DK. Pituitary pathology in Cushing's disease. Pathol Res Pract 1988;183:592–595.
Horvath E, Kovacs K, Killinger DW, Smyth HS, Platts ME, Singer W. Silent corticotropic adenomas of the human pituitary gland. Am J Pathol 1980;98:617–638.
Holck S, Wewer UM, Albrechtsen R. Heterogeneity of secretory granules of silent pituitary adenomas. Mod Pathol 1988;1:212–215.
De Keyzer Y, Lenne F, Bertagna X. Widespread transcription of the growth hormone-releasing peptide receptor gene in neuroendocrine human tumors. Eur J Endocrinol 1997; 137:715–718.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Tan, E., Ho, M. & Rajasoorya, C. Metamorphosis of a Non-Functioning Pituitary Adenoma to Cushing's Disease. Pituitary 3, 117–122 (2000). https://doi.org/10.1023/A:1009961925780
Issue Date:
DOI: https://doi.org/10.1023/A:1009961925780