SFE2002 Poster Presentations Clinical case reports (21 abstracts)
Surgical Stimulation of a Silent Corticotroph to Secrete
N Quinn 1 , N Phillips 2 , M Nelson 3 , L Bridges 4 & P Belchetz 1
1Dept of Endocrinology; 2Dept of Neurosurgey; 3Dept of Neuroradiology; 4Dept of Neuropathology.
A 71 year old woman presented with visual loss. MR scanning demonstrated a massive invasive pituitary adenoma. She had no features of endocrine dysfunction. 0900hrs cortisol was 278nmol/L. Haemorrhage limited transphenoidal surgery to biopsies. Postoperative CSF leak was repaired 3months later. Histology revealed a corticotroph adenoma on immunostaining.
At endocrine follow-up, afternoon cortisol was 645nmol/L, and 875nmol/L fasting, falling after glucagon stimulation. Clinically, she was mildly cushingoid. DDAVP caused massive ACTH and Cortisol secretion, diurnal cortisol rhythm was abolished, and cortisol was inadequately suppressed after low dose dexamethasone. The tumour appeared larger on repeat MRI but vision had greatly improved.
Silent corticotrophs are renowned for their invasive potential. Rarely, silent corticotrophs develop active Cushing's disease. Did surgery play a role in activating ACTH/Cortisol secretion in this case?
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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