Endocrine Abstracts

Objective: The management of pituitary tumors causing Cushing’s Disease are a multidisciplinary challenge to clinicians with neurosurgery as a first line treatment followed by the radiotherapy and pharmacotherapy including chemiotherapy.Such tumors are difficult to treat with high rate of recurrence. To date only 25 patients with Cushing Disease treated with the new alkylating agent temozolamide (TMZ) have been reported.

Materials and methods: Sixty-one year old male patient was diagnosed as Cushing’s Disease in the course of pituitary macradenoma in 2011. Patient underwent four transphenoidal non radical neurosurgeries (2012, 2013) with rapid tumor progression, with postsurgical insufficiency of gonadal and thyroid axis, repeated non radical bilateral adrenalectomy (2012, 2013) and stereotactic radiotherapy and gamma knife surgery (2013, 2015). Histopatological examination revealed macroadenoma with high cell polimorfism and presence of the Crooke’s cells. Patient has been treated with 600 mg of ketokonazol. From 2015 treated with six cycles of temozolamide with important clinical improvement with the 23–25% decrease of morning and midnight cortisol and the decrease of ACTH from 1317 to 689 pg/ml. In the control MRI the size of the tumor was the same as in the previous examination MRI-(30×35×35 mm). There were not side effects of TMZ. After oncological consultation the decision to continue TMZ treatment was undertaken. After the 9th cycle of TMZ in XII 2015 in the PET examination there was an increase in the size of the tumor to 35×53×54 mm. ACTH increased to 779 pg/ml, with morning and midnight cortisol increase. The clinical status and sight deterioration and hearing loss were observed.

Conclusions: The treatment with TMZ was effective and safe during first six cycles with progression observed during the continuation of the treatment. Further studies on the effectiveness of TMZ and other agents should be continued in patients with corticotrophin tumors resistant to conventional therapy.