Endocrine Abstracts

Cushing’s syndrome (CS) is a relatively rare disease characterized by autonomous hypersecretion of cortisol. The incidence of CS is estimated to be equal to 2–3 cases per million inhabitants per year.The incidence of acromegaly is 3–4 patients per 1 000000 per year. The disease is caused by hypersecretion of growth hormone which is mainly caused by benign tumour of the pituitary gland. In our case report we present a 41 - year - old woman suffering from both Cushing’s syndrome and acromegaly. The patient was examined in National Institute of Endocrinology and Diabetology Lubochňa for a centripetal type of obesity and hirsutism. Laboratory tests revealed high plasma cortisol levels without circulating variation, hypercortisoluria and elevated plasmatic levels of adrenocorticotropic hormone (ACTH). A 2 mg dexamethasone blockade was performed without adequate cortisol suppression in serum and urine up to 8 mg blockade resulted in cortisolure suppression. A magnetic resonance imaging (MR) scan revealed suspect picoadenoma of the pituitary gland (size 2 mm). Subsequently trans-sphenoidal resection was performed. Histopathological and immunohistochemical examinations did not reveal the ACTH-producing pituitary adenoma. After surgery hypercortisolism persisted with newly revealed high plasma insulin-like growth factor-1 (IGF-1), basal growth hormone (GH) was normal. We subsequently performed oGTT test with GH which was not suppressed after glucose administration. Treatment withKetoconazole at dose 200 mg 1/ 2-0-1 and somatostatin analogues (Lanreotide) at dose 120 mg every 42 days were initiated. Control magnetic resonance imaging of the sella demonstrated small tumour of pituary gland of size 3×5 mm. Later 3 years after first surgery another trans-sphenoidal resection of residue was performed. Histological and immunohistochemical examinations did not confirm adenoma with ACTH and RH secretion.After second surgery, IGF-1 plasma levels were not normalized with persistence of hypercortisolism. The treatment with Lanreotide at the initial dose as well as Ketoconazole was reinitiated (with increased dose of Ketoconazole to 1-1-1 tbl per 200 mg).