Consecutive resections of double pituitary adenoma for resolution of Cushing disease: illustrative case.

Autor:	Armstrong SA; Departments of1Neurosurgery and., Tavakoli S; Departments of1Neurosurgery and., Shah I; Departments of1Neurosurgery and., Laing BR; Departments of1Neurosurgery and., Coss D; 3Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin; and., Ioachimescu AG; Departments of1Neurosurgery and.; 2Department of Medicine, Division of Endocrinology and Molecular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin., Findling J; 2Department of Medicine, Division of Endocrinology and Molecular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin., Zwagerman NT; Departments of1Neurosurgery and.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Case lessons [J Neurosurg Case Lessons] 2023 Nov 27; Vol. 6 (22). Date of Electronic Publication: 2023 Nov 27 (Print Publication: 2023).
DOI:	10.3171/CASE23485
Abstrakt:	Background: Double pituitary adenomas are rare presentations of two distinct adenohypophyseal lesions seen in <1% of surgical cases. Increased rates of recurrence or persistence are reported in the resection of Cushing microadenomas and are attributed to the small tumor size and localization difficulties. The authors report a case of surgical treatment failure of Cushing disease because of the presence of a secondary pituitary adenoma. Observations: A 32-year-old woman with a history of prolactin excess and pituitary lesion presented with oligomenorrhea, weight gain, facial fullness, and hirsutism. Urinary and nighttime salivary cortisol elevation were elevated. Magnetic resonance imaging confirmed a 4-mm3 pituitary lesion. Inferior petrosal sinus sampling was diagnostic for Cushing disease. Primary endoscopic endonasal transsphenoidal resection was performed to remove what was determined to be a lactotroph-secreting tumor on immunohistochemistry with persistent hypercortisolism. Repeat resection yielded a corticotroph-secreting tumor and postoperative hypoadrenalism followed by long-term normalization of the hypothalamic-pituitary-adrenal axis. Lessons: This case demonstrates the importance of multidisciplinary management and postoperative hormonal follow-up in patients with Cushing disease. Improved strategies for localization of the active tumor in double pituitary adenomas are essential for primary surgical success and resolution of endocrinopathies.
Databáze:	MEDLINE
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