‘Extraordinarily rare’ Cushing’s case treated with pituitary surgery
Woman, 30, had 2 treatment-resistant pituitary gland conditions: Report
A young woman with Cushing’s disease and acromegaly — marked by the abnormal growth of certain body parts due to pituitary gland dysfunction — saw her symptoms ease after undergoing surgery to remove a large hormone-producing tumor that caused both rare conditions, a study from Bangladesh reported.
“The simultaneous occurrence of Cushing disease and acromegaly is rare and presents a significant diagnostic and therapeutic challenge,” the researchers wrote in describing the woman’s case.
Acromegaly occurs when the brain’s pituitary gland produces excessive amounts of growth hormone, making certain body parts grow abnormally. Cushing’s disease, meanwhile, is caused by the excessive production of adrenocorticotropic hormone, or ACTH, that triggers the overproduction of cortisol. The disease, as was the case here, is usually caused by a pituitary gland tumor.
While calling this co-occurrence “extraordinarily rare,” the researchers noted that “both conditions stem from hyperpituitarism,” and wrote that “this case highlights the pivotal role of surgical intervention in managing … pituitary [tumors].”
The case was detailed in a study titled “Treatment-resistant Cushing disease and acromegaly in a young woman: A case of functional pituitary macroadenoma,” which was published in the journal Radiology Case Reports.
Pituitary surgery removed large, benign tumor linked to both conditions
Cushing’s syndrome encompasses conditions driven by high cortisol levels, or hypercortisolism. Cushing’s disease, one of the most common types, is usually caused by benign tumors, called pituitary adenomas, in the brain’s pituitary gland.
These tumors are classified as macroadenomas if they measure more than 10 mm in size, and as functional adenomas if they produce and release hormones, such as ACTH or growth hormone.
Here, researchers described the rare case of a 30-year-old woman with a single pituitary macroadenoma who developed both conditions.
The patient had typical Cushing’s signs, such as central obesity, a moon face, and fat buildup between the shoulder blades. She also had thin skin, experienced easy bruising, and had muscle weakness and high blood pressure.
Lab tests revealed she had high levels of ACTH in the blood, as well as elevated levels of cortisol in the urine. Her blood sugar levels also were elevated, supporting a diagnosis of diabetes.
In addition, the woman had signs of acromegaly, including enlarged hands and feet, that were consistent with elevated insulin-like growth factor, known as IGF-1. Other acromegaly signs were nose broadening, an extension of the lower jaw, and a prominent forehead.
She also had abnormally high levels of the hormone prolactin in the bloodstream, which is normally responsible for stimulating milk production during and after pregnancy.
An MRI scan revealed the presence of a pituitary macroadenoma that was compressing other brain structures, which explained the patient’s partial loss of sight.
The woman was diagnosed with both Cushing’s disease and acromegaly caused by a functioning pituitary adenoma. She then started treatment with octreotide (sold as Sandostatin and others) to reduce growth hormone and ACTH production. However, the treatment provided little benefit, with hormone levels remaining high and symptoms poorly controlled.
[This case highlights] the role of a multidisciplinary approach involving endocrinology, radiology, and neurosurgery, demonstrating its effectiveness in resolving hormonal overproduction and alleviating symptoms.
She then underwent surgery to remove the pituitary macroadenoma through an endonasal endoscopic transsphenoidal procedure, a minimally invasive surgical method that involves removing pituitary tumors through the nose. The tumor was completely removed without complications.
After surgery, the woman saw her ACTH, IGF-1, and prolactin levels normalize, leading to a clinical remission of both Cushing’s disease and acromegaly. She did not require immediate hormone replacement therapy.
The researchers noted that “early diagnosis is critical for optimizing outcomes in patients with hyperpituitarism and mitigating complications.” They also highlighted the important role that pituitary surgery played in treating the woman’s condition.
According to the team, the woman’s case highlights “the role of a multidisciplinary approach involving endocrinology, radiology, and neurosurgery, demonstrating its effectiveness in resolving hormonal overproduction and alleviating symptoms.”
Further, the researchers wrote, “this case underscores the need for clinicians to remain vigilant when evaluating overlapping endocrine features to avoid delays in diagnosis and treatment.”
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