Endocrine Abstracts

A 32-year-old male was referred by his GP with a 6-month history of lethargy, erectile dysfunction, weight gain, acne and hypertension. He denied exogenous steroid usage and had no other past medical history. On examination, he had classical features of Cushing’s including moon face, central adiposity, proximal muscle weakness and purple striae.

Investigations confirmed Cushing’s from a pituitary source as shown in the table below. MRI pituitary showed a probable pituitary microadenoma on the left side. His case was discussed at the pituitary MDT and was offered surgery. About 2 months before surgery, he developed sudden severe headache for which he attended A&E department where he was discharged after pain control. Following this episode his symptoms of Cushing’s improved, started to lose weight. He underwent surgery but histology revealed normal pituitary tissue.

Three months after surgery, he had lost 10 kg in weight with a normalising body habitus. Blood pressure was also back to normal. A repeat low dose dexamethasone suppression test was normal with 0900 h serum cortisol of 12 nmol/l and his full pituitary profile was also normal. Repeat MRI pituitary showed a normal pituitary gland.

Conclusion: Spontaneous remission in pituitary Cushing’s disease has been documented in very few cases. The possible etiology is considered to be possible infarction or haemorrhage into the adenoma. We suspect that he might have infarcted his pituitary shortly before his surgery when he attended the A&E with severe headache.