An unusual case of Cushing's syndrome due to bihormonal ACTH–prolactin secreting pituitary macroadenoma with rapid response to cabergoline
| Autor: | Ian M. Holdaway, Shalini Kunasegaran, Michael S. Croxson, Rinki Murphy |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adenoma
Male endocrine system medicine.medical_specialty Cabergoline Pituitary disorder Pituitary macroadenoma Antineoplastic Agents 030209 endocrinology & metabolism Article Young Adult 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Endocrine system Pituitary Neoplasms Prolactinoma Ergolines Cushing Syndrome Hydrocortisone business.industry General Medicine medicine.disease Prolactin ACTH-Secreting Pituitary Adenoma Endocrinology 030220 oncology & carcinogenesis business hormones hormone substitutes and hormone antagonists medicine.drug Rare disease |
| Zdroj: | BMJ Case Reports. :bcr-2017 |
| ISSN: | 1757-790X |
| DOI: | 10.1136/bcr-2017-219921 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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