MANAGEMENT OF RECURRENT POSTOPERATIVE CUSHING’S DISEASE

Abstract

Although adenomectomy remains the first-line treatment in Cushing’s disease, it is not always
curative for most patients. Sooner or later persistent or recurrent disease can be found in some
cases. Case report: A 13-year-old girl was admitted for weight gain, menstrual disturbances, and
transient headache. Hormonal profile confirmed the clinical suspicion of Cushing’s disease.
Pituitary MRI highlighted a microadenoma of 5.2 mm resected through transsphenoidal
adenomectomy. No complications were registered during the procedure. After a 7 days
hospitalization, the patient was discharged without any medications. Periodic evaluations
confirmed the disease’s remission that was maintained for a period of 2 years. During this period,
the patient received only thyroxine and progesterone treatment. Two years after surgery, the
adrenal hormone profile confirmed the recurrence of the disease. According to the patient’s age,
ketoconazole and cabergoline treatment was instituted without any significant improvement.
Because no obvious tumor mass has been revealed on the pituitary MRI, pasireotide treatment was
introduced at the age of 18. An obvious improvement in the hormonal profile was achieved after
three months of treatment. Cushing’s disease control requires therapeutic alternatives consistent
with the patient’s age and the complications of the disease. Pasireotide treatment may be a good
choice for adult patients with recurrent disease after transsphenoidal adenomectomy.