Rare Cushing’s Case Linked to Tumors in Pituitary, Brain Membranes

Although rare, Cushing’s disease associated with a tumor in the pituitary gland — a pea-size gland found deep within the brain — may occur in patients who also have a meningioma, a type of tumor that arises from the membranes that cover the brain within the skull, a case report highlights.

However, additional studies will be needed to investigate the mechanisms underlying the co-occurrence of both conditions.

The study, “Cushing’s Disease Caused by a Pituitary Microadenoma Coexistent with a Meningioma: A Case Report and Literature Review,” was published in the International Journal of General Medicine.

Cushing’s disease is caused by a tumor in the pituitary gland, causing this gland to produce excessive amounts of adrenocorticotropic hormone (ACTH). The abnormally high levels of ACTH, in turn, lead to the excessive production of the stress response hormone cortisol, which has a variety of effects throughout the body.

In the new report, researchers described the case of a 47-year-old woman who went to the endocrinology department of their hospital with multiple complaints, including swelling and pain in her legs, purplish striae (lines), and bloating in her abdomen that she had been experiencing for the past nine months.

Two years prior, the patient had undergone surgical removal of her uterus (hysterectomy) due to a uterine tumor (hysteromyoma). Otherwise, she had no noteworthy medical history.

Upon physical examination, the patient had many features typical of Cushing’s, including obesity around her midsection, moon face (swelling in the face), buffalo hump (hump between the shoulders), and swollen feet.

Further laboratory tests showed she had abnormally high levels of ACTH and cortisol, as well as abnormal blood pressure and excessive levels of fatty molecules circulating in her bloodstream.

A brain MRI scan then revealed she had a tumor in the pituitary gland, located at the base of the brain. The scan also showed she had a second tumor: a meningioma, which grows from the membranes that cover the brain (called the meninges), that did not cause her to experience any obvious symptoms.

“In our case, [the tumor in the pituitary gland] was the cause of Cushing’s syndrome, while the meningioma was an incidental imaging observation,” the researchers wrote.

The patient underwent two separate surgical procedures, one month apart, to remove each of the two tumors. Soon after the removal of the pituitary tumor, her cortisol levels decreased. The patient was put on cortisol-replacement therapies to prevent her cortisol levels from dipping too low following surgery. Treatment lasted for one year.

A year after surgery, the patient was in remission. No tumors were observed on MRI scans, and symptoms of Cushing’s were alleviated. She lost 30 kg (about 66 pounds), and various clinical parameters, including blood pressure and blood sugar levels, returned to a normal range.

The co-existence of a Cushing’s-causing pituitary tumor and a meningioma “is very rare,” the researchers noted.

Based on available literature, they stated it is possible that the two tumor types may be biologically linked — for example, it is conceivable that excess ACTH or cortisol, as a result of a pituitary tumor, could predispose one to develop a meningioma.

Yet, they also noted that “further studies are required to understand whether ACTH or cortisol are related to the occurrence and development of meningioma.”