An unusual case of Cushing's syndrome due to bihormonal ACTH-prolactin secreting pituitary macroadenoma with rapid response to cabergoline.

Autor:	Kunasegaran S; Department of Endocrinology, Auckland District Health Board, Auckland, New Zealand.; Department of Endocrinology, Waitemata District Health Board, Takapuna, New Zealand., Croxson MS; Department of Endocrinology, Auckland District Health Board, Auckland, New Zealand., Holdaway I; Department of Endocrinology, Auckland District Health Board, Auckland, New Zealand., Murphy R; Department of Endocrinology, Auckland District Health Board, Auckland, New Zealand.
Jazyk:	angličtina
Zdroj:	BMJ case reports [BMJ Case Rep] 2017 Aug 07; Vol. 2017. Date of Electronic Publication: 2017 Aug 07.
DOI:	10.1136/bcr-2017-219921
Abstrakt:	A 23-year-old man presenting with florid Cushing's syndrome was found to have high plasma ACTH and very high serum prolactin. Pituitary MRI showed a large invasive macroadenoma. Low-dose cabergoline promptly suppressed both ACTH and prolactin levels within 2 weeks, with unexpected clinical and biochemical hypocortisolism requiring hydrocortisone replacement. Secondary hypogonadism was reversed. Clinical and biochemical remission of his Cushing's syndrome together with significant shrinkage of his macroadenoma has been maintained for 1 year on cabergoline 0.5 mg twice weekly. Reduction in pituitary tumour volume and brisk fall in serum prolactin in response to low-dose cabergoline is regularly observed in patients with macroprolactinomas, but the concurrent fall in the plasma ACTH level and hypocortisolism was a pleasant surprise. We assume that he most likely has a single bihormonal adenoma that is enriched with dopamine-2 receptors. Competing Interests: Competing interests: None declared. (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
Databáze:	MEDLINE
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