, Volume 8, Issue 2, pp 81–87 | Cite as

Repeated Remissions of Cushing's Disease Due to Recurrent Infarctions of an ACTH-Producing Pituitary Macroadenoma

  • Abdullah Alarifi
  • Ali S. AlzahraniEmail author
  • Suzan Abdel Salam
  • Mohammed Ahmed
  • Imaduddin Kanaan


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.

Key Words

apoplexy Cushing's disease adrenal insufficiency 


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Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Abdullah Alarifi
    • 1
  • Ali S. Alzahrani
    • 1
    • 3
    Email author
  • Suzan Abdel Salam
    • 1
  • Mohammed Ahmed
    • 1
  • Imaduddin Kanaan
    • 2
  1. 1.Department of MedicineKing Faisal Specialist Hospital & Research CentreRiyadhSaudi Arabia
  2. 2.Department of NeurosciencesKing Faisal Specialist Hospital & Research CentreRiyadhSaudi Arabia
  3. 3.RiyadhSaudi Arabia

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