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Pituitary

, Volume 15, Supplement 1, pp 6–9 | Cite as

ACTH-producing remnants following apoplexy of an ACTH-secreting pituitary macroadenoma

  • Caroline Korsten Messer
  • Mary E. Fowkes
  • J. Lester Gabrilove
  • Kalmon D. Post
  • Honju Son
  • Alice C. Levine
Article

Abstract

Describe a case of apoplexy of an ACTH-producing pituitary adenoma which resulted not only in an empty sella with concurrent hypothyroidism, hypoprolactinemia, and hypogonadism but persistent hypercortisolemia from two distinct extrasellar remnants of the original adenoma. Review the literature to identify other similar cases. The patient’s medical history, physical exam, lab data, imaging exams and histopathological results were analyzed and compiled into a case report, and an extensive review of the literature was performed. Endocrinological data revealed hypercortisolism and an elevated ACTH with an otherwise suppressed pituitary axis. A pituitary MRI showed a macroadenoma in the left cavernous sinus in addition to an empty sella. An octreotide scan revealed lesions in the left sella turcica and the right sphenoid sinus. Tissue samples of both lesions stained positive for ACTH and negative for GH, prolactin, FSH, LH, and TSH. The lesions were surgically removed, and the patient treated with radiation and ketoconazole. This resulted in a significant decrease in ACTH and cortisol as well as a marked improvement in blood glucose control. The review of literature revealed the absence of any similar cases in the past. The patient presented with apoplexy of an ACTH-secreting pituitary macroadenoma with two hormonally active extrasellar remnants. Several cases in the literature describe recurrence of Cushing’s disease following infarction of ACTH-secreting adenomas. This is the first documented case of infarction of an ACTH-producing adenoma resulting in two distinct ACTH-producing remnants without recurrence of the original adenoma.

Keywords

Pituitary Cushing’s Infarction Apoplexy ACTH Cortisol Macroadenoma Sella 

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Caroline Korsten Messer
    • 1
    • 6
  • Mary E. Fowkes
    • 2
  • J. Lester Gabrilove
    • 3
  • Kalmon D. Post
    • 4
  • Honju Son
    • 5
  • Alice C. Levine
    • 3
  1. 1.Department of EndocrinologyMount Kisco Medical GroupMount KiscoUSA
  2. 2.Department of PathologyMount Sinai School of MedicineNew YorkUSA
  3. 3.Department of EndocrinologyMount Sinai School of MedicineNew YorkUSA
  4. 4.Department of NeurosurgeryMount Sinai School of MedicineNew YorkUSA
  5. 5.Department of Nuclear MedicineMount Sinai School of MedicineNew YorkUSA
  6. 6.New YorkUSA

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