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Failure of total hypophysectomy to remove intrasellar microadenoma in cushing’s disease

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Abstract

The pathological findings are described of a female patient with persistent Cushing’s disease after two unsuccessful transsphenoidal operations: a left transsphenoidal hemihypophysectomy followed by a total hypophysectomy 1 month later. The patient was finally cured by bilateral adrenalectomy but suddenly died of heart failure 4 months later. Postmortem examination did not show invasive ACTH-secreting tissue in the pituitary region or an ectopic ACTH-secreting tumor, as initially presumed. Instead, a very small corticotroph adenoma was located immediately under the diaphragm sellae at the left side. The reasons for surgical failure in Cushing’s disease are discussed. As in our patient, a missed small intrasellar adenoma must not be excluded when “total” hypophysectomy fails to cure Cushing’s disease.

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Authors and Affiliations

  1. Department of Endocrinology, A.Z. Middelheim, Lindendreef 1, B-2020, Antwerp, Belgium

    J. Verhelst & C. Mahler

  2. Department of Neurosurgery, A.Z. Middelheim, Antwerp

    R. Klaes

  3. Department of Pathology, Academic Hospital Jette, Free University of Brussels, Belgium

    G. Smets, G. Klöppel & A. Hoorens

  4. Department of Morphology, Life Sciences, Janssen Pharmaceutica, Beerse

    G. Smets

  5. Department of Endocrinology, University Hospital Antwerp, Belgium

    A. Hoorens & R. Abs

Authors
  1. J. Verhelst
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  2. R. Klaes
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  3. G. Smets
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  4. G. Klöppel
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  5. A. Hoorens
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  6. R. Abs
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  7. C. Mahler
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Verhelst, J., Klaes, R., Smets, G. et al. Failure of total hypophysectomy to remove intrasellar microadenoma in cushing’s disease. Endocr Pathol 3, 205–208 (1992). https://doi.org/10.1007/BF02921364

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  • DOI: https://doi.org/10.1007/BF02921364

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