Session: SUN 163-194-Pituitary Disorders & Case Reports
Poster Board SUN-184
Clinical Case: A 30-year-old woman with a history of hypertension and ESRD due to focal segmental glomerulosclerosis on peritoneal dialysis presented for evaluation of worsening diabetes, facial plethora and proximal muscle weakness. A midnight salivary cortisol was elevated (1.03 µg/dL, n<0.112 µg/dL) and an overnight 1mg dexamethasone suppression test was abnormal (cortisol after 1mg of dexamethasone 27.6 µg/dL, n 0-5 µg/dL). Consistent with Cushing’s disease, her ACTH was also elevated following 1mg dexamethasone (ACTH 38 pg/mL, n 6-58pg/mL). Other abnormal labs include the following: elevated GH (73.7 ng/mL, n 0.01-8 ng/mL), Igf-1 (>1600 ng/mL, n 71-352 ng/mL), and prolactin (60.4 ng/mL, n 2.8-26 ng/mL). An MRI of the pituitary showed a 31 x 26 mm sellar mass with invasion into the clivus, sphenoid sinus, and bilateral cavernous sinuses. Despite detailed transphenoidal surgery, complete resection could not be accomplished due to the extensive invasion. Immunohistochemistry of the resected adenoma showed strong staining for GH with scattered cells reactive for ACTH and prolactin. AM cortisol decreased immediately following surgery (6.5 µg/dL, n 6-23 µg/dL). She received adjuvant radiotherapy with 20Gy administered in a single fraction one month after surgery.
Three months after radiation, she had a persistently abnormal overnight 1mg dexamethasone suppression test (serum free cortisol following 1mg dexamethasone 2.19 µg/dL, n 0.31-1.19 µg/dL; dexamethasone 849 ng/dL, n 140 - 295 ng/dL), elevated Igf-1 (>1600 ng/mL, n 71-352 ng/mL) and elevated GH (4.05 ng/mL, n 0.01-8 ng/mL). An α-subunit was not elevated (1.1 ng/mL, n <= 1.2 ng/mL). Follow-up MRI of the pituitary revealed significant resolution, however, residual tumor was evident in the right cavernous sinus. Her clinical symptoms of hypercortisolemia and facial plethora resolved following surgery. P53 and MIB 1 index are pending.
Conclusion: This is the first description of a pituitary adenoma secreting ACTH, GH, and PRL presenting with Cushing’s disease in the setting of ESRD.
Nothing to Disclose: TCM, FS, DS, WTC, DA
*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