DIFFERENT SURGICAL OPTIONS IN CUSHING’S DISEASE

Ana Valea1,2, Cristina Ghervan1,2,Mara Carsote3,4, Simona Elena Albu3,5, Carmen Emanuela Georgescu 1,2

1The University of Medicine and Pharmacy ”Iuliu Hatieganu”, Cluj-Napoca, Romania
2Clinical County Hospital, Cluj-Napoca, Romania
3The University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
4“C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
5The University Emergency Hospital, Bucharest, Romania

Corresponding author: Mara Carsote
Phone no. 0040213172041
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Abstract

Cushing’s disease represents a severe endocrine disorder caused by prolonged exposure to pituitary tumor-related high cortisol levels. Pituitary surgery is not always successful and other approaches as radiotherapy, direct suppressors of adrenocortical and/or pituitary activity, bilateral adrenalectomy are necessary. Case report 1 - A 15-year-old female was admitted at the age of 14 for secondary amenorrhea, weight gain and emotional disturbances. Pituitary MRI revealed 2 microadenomas of 3 mm, respective 3.5 mm. The pathological report confirmed benign features. After 12 days of hospitalization, the patient was discharged with the recommendation of levothyroxine. Within the first year after surgery, the thyroid insufficiency due to pituitary surgery remitted. Case report 2 - A 66-year-old male presented at the age of 37 with headache, weight gain, high blood pressure and Cushing’s disease was confirmed. Pituitary radiotherapy was preferred to pituitary surgery since no pituitary tumor was revealed at imagery. 3 years later, two times open bilateral adrenalectomy was performed due to persistent hypercortisolism. The histology exam revealed bilateral adrenal hyperplasia. After discharge, lifelong therapy for adrenal insufficiency was required. 32 months later, the clinical picture was complicated with Nelson’s syndrome based on skin hyper-pigmentation and high ACTH (Adrenocorticotropic Hormone) despite no obvious pituitary adenoma was revealed by imagery. Weekly cabergoline was introduced to correct the increased ACTH. Transsphenoidal hypophysectomy represents the treatment of choice for ACTH- producing pituitary tumors. The cases when pituitary surgery is not optional or successful, a second surgical procedure as bilateral adrenalectomy might become necessary.

Keywords: Cushing’s disease, pituitary tumor, transsphenoidal hypophysectomy, adrenalectomy, hypercortisolism

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