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Surgical Management of Hypercortisolism from ACTH-Secreting Pituitary Adenomas

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Diagnosis and Management of Endocrine Disorders in Interventional Radiology

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Abstract

Cushing syndrome (CS) is the constellation of findings that are noted from prolonged exposure to glucocorticoids. Cushing’s disease (CD) results from a benign monomorphic pituitary corticotroph adenoma that secretes excessive adrenocorticotropic hormone (ACTH). Increased ACTH stimulates secretion of cortisol by the adrenal glands, resulting in supraphysiological levels of endogenous steroid resulting in the combination of symptomatology and findings characteristic of CS. ACTH-secreting pituitary tumors resulting in CD are generally small; therefore diagnosis relies on imaging and lab workup. While diagnostic challenges exist, inferior petrosal sinus sampling has significantly improved the ability of confirmatory diagnosis and can assist with localization of tumors not seen on cross-sectional imaging. Surgical management via an endonasal transsphenoidal approach of ACTH-secreting pituitary adenomas resulting in CD remains the first-line therapy with excellent success at experienced centers. Surgical complications are rare. The goals of surgery remain gross total resection resulting in biochemical remission of hypercortisolism with simultaneous maintenance of pituitary function. Non-remission remains a challenge and options to treat this include revision surgery, medical therapies, and radiation therapy.

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, University of North Carolina Medical Center, Chapel Hill, NC, USA

    Justin C. Morse, Brian D. Thorp & Adam J. Kimple

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  1. Justin C. Morse
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  2. Brian D. Thorp
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  3. Adam J. Kimple
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Correspondence to Adam J. Kimple .

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Editors and Affiliations

  1. Division of Vascular and Interventional RadiologyDepartment of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA

    Hyeon Yu

  2. Division of Vascular and Interventional RadiologyDepartment of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA

    Charles T. Burke

  3. Division of Vascular and Interventional RadiologyDepartment of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA

    Clayton W. Commander

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Morse, J.C., Thorp, B.D., Kimple, A.J. (2022). Surgical Management of Hypercortisolism from ACTH-Secreting Pituitary Adenomas. In: Yu, H., Burke, C.T., Commander, C.W. (eds) Diagnosis and Management of Endocrine Disorders in Interventional Radiology. Springer, Cham. https://doi.org/10.1007/978-3-030-87189-5_14

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  • DOI: https://doi.org/10.1007/978-3-030-87189-5_14

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