Endocrine Abstracts

Introducion: Pituitary apoplexy is an endocrine emergency that is a rare complication of pituitary adenomas and exceptional in ACTH adenomas. We report a case of apoplexy on corticotropic adenoma with intermittent secretion.

Case report: The patient was 41 years old woman, she presented in 2012 a period of symptomatic hypercortisolism. Urinary free cortisol was elevated to 113 μg/24 h, Low-dose dexamethasone testing was negative, ACTH was elevated to 40.2 pmol/l, the high-dose dexamethasone suppression test was positive, a pituitary MRI and a thoraco pancreatic scanner were normal; These finding led us to a Cushing disease with normal MRI. The patient was revaluated 5 months later, she was clinically better and biochemically presented an eucorticism. 1 year later she presented relapsed symptoms and a biochemical recurrence of hypercortisilosm (high urinary cortisol: 125.7 μg/24 h and negative Low-dose dexamethasone testing). an intermittent Cushing was suggested. Brutally the patient presented a sudden tumor syndrome, pituitary MRI revealed an intrasellar arachnoidocele approving the apoplexy of an adrenocorticotropic pytuitary adenoma that was unnoticed on the previous pituitary MRI. Endocrine and ophthalmological examinations were normal.The patient was revaluated 6 months later and she was clinically better, The Urinary free cortisol and pituitary function testing showed a good pituitary hypothalamic function.

Conclusion: Apoplexy adenomatosis is a rare complication. Evolution can be marked by a cure of Cushing’s disease, a persistence of Cushing’s syndrome due to a tumor residue, or a remission followed by a recurrence of Cushing’s disease. In our case, the clinical, biological and radiological evolution was in favor of an intermittent Cushing syndrome spontaneously regressive by apoplexy of a corticotropic adenoma.