ECE2015 Eposter Presentations Pituitary: clinical (121 abstracts)
Optic neuropathy following radiotherapy for Cushing's disease followed by the diagnosis of pituitary carcinoma
Krystallenia Alexandraki , Georgios Boutzios , Georgios Nikolopoulos , Panagoula Roussaki , Maria Chrysochoou , Eleftherios Chatzellis , Marina Tsoli , Maria Kaltsatou , Panagiotis Moschouris & Gregory Kaltsas
Endocrine Unit, Department of Pathophysiology, Laiko Hospital, University of Athens Medical School, Athens, Greece.
Introduction: ACTH-secreting pituitary carcinomas are rare neoplasms but there are not factors till now to predict their aggressive evolution nor a standard practice to their management.
Case report: We report a 43-year-old female patient presented in 1990 with Cushing’s syndrome due to ACTH-secreting pituitary microadenoma who had been submitted on trans-sphenoidal surgery with cure as defined by post-operative cortisol serum levels <50 nmol/l. In 2000 she represented with clinical, biochemical and imaging recurrence, hence, 10 years after her first remission. She had repeat surgery similarly with cure as defined by post-operative cortisol serum levels <50 nmol/l but again a recurrence within 2 years. Since, no tumour was documented in imaging studies, she received external beam irradiation (in total a dose as high as 54 Gy) in 2005. However, her hypercortisolaemia was still uncontrolled and she was submitted in bilateral adrenalectomy. Ten months after radiotherapy, the patient was presented with declining visual acuity, and radiation-induced optic neuropathy (RON) was diagnosed. Despite treatment with glucocorticoids and hyperbaric oxygen, her vision did not improve. Two years later she was hyperpigmented with increased ACTH plasma levels. The ACTH plasma levels continued to increase reaching very high levels and in 2010 FDG–PET and conventional imaging confirmed the diagnosis of pituitary carcinoma with multiple liver metastasis and local disease. Since today we are trying to control, her disease with several recent chemotherapeutic and biological agents (cisplatin+etoposide and temozolamide+bevacizumab).
Conclusions: This case implies that the appearance of pituitary carcinoma cannot be excluded by the cure post trans-sphenoidal surgery nor can be prevented by a high dose of irradiation even this is so high to cause RON.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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