Endocrine Abstracts

Introduction: Cushing’s disease is a rare condition observed in about 8–10% of patients with pituitary tumor. In the majority of cases, corticotroph adenomas are small, intrasellar and less than 10mm in diameter, while macroadenomas occur in 4–10% of the patients. An observation of two clinical cases is reported.

The observation

Case number 1: a female patient aged 31, hospitalized for suspected Cushing’s disease. Diagnosis mentioned in the context of an exploration for fracture osteoporosis. The 24-h urinary free cortisol (UFC): 560 nmol/l, ACTH: 148.9 pg/ml, midnight cortisol: 350 nmol/l. With pituitary MRI: pituitary macroadenoma of 19 × 10 × 13 mm, extending to the level of the right cavernous sinus, arriving in contact with the right internal carotid artery without invading it. High-dose dexamethasone overnight suppression test, and a corticotrophin releasing hormone (CRH) test, were positive. The patient had a trans-sphenoidal adenomectomy with histological confirmation, corticotropic adenoma KI67 at 7%. The post-operative evaluation at 3 months is in progress. Case number 2: 60 year old male patient with a history of hypertension, type 2 diabetes, sleep apnea syndrome. Diagnosis is supected in front of the clinical aspect suggestive of a cushing syndrome. The 24-h urinary free cortisol (UFC): 5760 nmol/24 h, ACTH: 183.3 pg/ml. Pituitary MRI: macro adenoma of the anterior pituitary gland measured at 14 × 15 × 15 mm, developed mainly on the right side without invasion of the pituitary stem without invasion of the optic chiasm or carotid arteries. High-dose dexamethasone overnight suppression test was negative, but corticotrophin releasing hormone (CRH) test was positive. Patient referred in neurosurgery.

Conclusion: Cushing’s disease is rare, even rarer in corticotropic macro adenomas, the latter can be secreting and clinically symptomatic, are often associated with less glucocorticoid suppression than micro adenomas, and pose a problem of management since they are often severe and aggressive.