Endocrine Abstracts

Introduction: Cushing disease is the most common cause of endogenous hypercortisolism. Pituitary surgery is the first-line treatment and bilateral adrenalectomy is the option of last resort due to its severe consequences.

Observation: This is a 24-year-old patient followed for cushing disease revealed by a severe cushing syndrome, a urinary cortisol at 20 times normal and negative dexamethasone suppression test with a pituitary microadenoma on MRI. He was operated with an anatomopathological result of an acidophilic pituitary adenoma expressing anti prolactin and anti ACTH antibodies with a proliferation index (KI 61) at 1%. The exploration in post-pituitary surgery revealed the persistence of the severe Cushing’s syndrome with discovery of a right adrenal mass in favor of an adenoma. The patient underwent bilateral laparoscopic adrenalectomy with no histological evidence of malignancy. He was put on replacement therapy. The symptoms of hypercortisolism improved (weight, hypertension, diabetes, depression).

Discussion: Cushing disease is responsible for severe morbidity and its management is a therapeutic challenge. Bilateral adrenalectomy was chosen as the last resort in our case, given the severity of symptomatology. Monitoring by adrenocorticotropic hormone and pituitary MRI is necessary because of the risk of developing Nelson’s syndrome.

Keywords: Hypercortisolism-Cushing disease -treatment-adrenalectomy