Session: SUN 163-194-Pituitary Disorders & Case Reports
Poster Board SUN-181
CASE REPORT: A 40-year-old woman was referred to our institution due to oligomenorrhea, in April, 2010. On physical examination, she presented with typical features of Cushing’s syndrome, including moon fascies, truncal obesity with supraclavicular fat pads, hirsutism and mild hypertension. Blood tests showed urinary free cortisol level (UFC) of 456µg/24 hs [normal range (NR): 20-90)], late night salivary cortisol: 0.76 µg/dl (NR: 0.08-0.36) and cortisol post 1-mg-dexametasone test of: 2.6 µg/dl. Due to an ACTH level of 70 pg/ml (NR: 5-60), a pituitary MRI was requested but medical follow up was discontinued by the patient. In March, 2012, the patient returned to medical care. She didn’t have any of the typical features of Cushing’s syndrome that were observed two years ago. She referred that between March and August last year suffered from severe headache, fatigue, dizziness, vomit and diarrhea. During this period she lost 30 Kg. Biochemical tests revealed serum cortisol level of 8 µg/dl, UFC of 15 µg/24 hs and late night salivary cortisol <0.08 µg/dl. She had not received any corticosteroid replacement during this period. The MRI of the pituitary gland performed in 2010 showed a 7-mm lesion on middle of the gland with low signal intensity on a coronal T1 weighted image after gadolinium injection. A spontaneous remission of Cushing´s disease after presumed pituitary apoplexy with hypoadrenalism was suspected. A new MRI showed disappearance of the microadenoma, with partial arachnoidocele and lateralization of the pituitary stalk. The patient was reassessed at regular intervals during the last year. Endocrine tests showed recovery of pituitary-adrenal axis and preservation of other pituitary functions.
CONCLUSION: Spontaneous remission of Cushing`s disease is considered rare. Nevertheless the knowledge of this possible outcome is important in order to prevent its complications. Recurrence of Cushing`s disease may occur up to several years post remission. Therefore careful patient follow-up is required.
Nothing to Disclose: KM, MGJ, APL, MWV, CG, MCP, JMF
*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm
See more of: Abstracts - Orals, Featured Poster Presentations, and Posters