DIFFERENT SURGICAL OPTIONS IN CUSHING’S DISEASE

Abstract

Cushing’s disease represents a severe endocrine disorder caused by prolonged exposure topituitary tumor-related high cortisol levels. Pituitary surgery is not always successful and otherapproaches as radiotherapy, direct suppressors of adrenocortical and/or pituitary activity, bilateraladrenalectomy are necessary. Case report 1 - A 15-year-old female was admitted at the age of 14for secondary amenorrhea, weight gain and emotional disturbances. Pituitary MRI revealed 2microadenomas of 3 mm, respective 3.5 mm. The pathological report confirmed benign features.After 12 days of hospitalization, the patient was discharged with the recommendation oflevothyroxine. Within the first year after surgery, the thyroid insufficiency due to pituitary surgeryremitted. Case report 2 - A 66-year-old male presented at the age of 37 with headache, weight gain,high blood pressure and Cushing’s disease was confirmed. Pituitary radiotherapy was preferred topituitary surgery since no pituitary tumor was revealed at imagery. 3 years later, two times openbilateral adrenalectomy was performed due to persistent hypercortisolism. The histology examrevealed bilateral adrenal hyperplasia. After discharge, lifelong therapy for adrenal insufficiencywas required. 32 months later, the clinical picture was complicated with Nelson’s syndrome basedon skin hyper-pigmentation and high ACTH (Adrenocorticotropic Hormone) despite no obviouspituitary adenoma was revealed by imagery. Weekly cabergoline was introduced to correct theincreased ACTH. Transsphenoidal hypophysectomy represents the treatment of choice for ACTH-producing pituitary tumors. The cases when pituitary surgery is not optional or successful, a secondsurgical procedure as bilateral adrenalectomy might become necessary.