Abstract
ABSTRACTObjective: To present two clinical cases of pediatric Cushing disease caused by adrenocorticotropic hormone secreting pituitary adenomas, which were diagnosed by magnetic resonance imaging using 3 Tesla technology.Case description: Two cases of Cushing disease in 9-year-old children are reported. Both children presented pituitary adenomas that were smaller than 5 mm at their largest diameter, and which were not seen by standard 1.5 Tesla resonance. One of the patients was submitted to bilateral and simultaneous catheterization of the inferior petrosal sinus, but the result was undetermined. In both cases, the pituitary adenoma was detected by 3 Tesla magnetic resonance imaging. Both patients underwent transsphenoidal surgery and were cured.Comments: Cushing disease presents high morbidity. Therefore, early diagnosis and prompt treatment are essential. It is usually caused by adenomas that are smaller than 5 mm in diameter. Surgery is the first line of treatment, and effective methods of locating the adenoma are necessary for greater therapeutic success. This report suggests that the 3 Tesla magnetic resonance imaging is more sensitive, and thus able to detect pituitary microadenomas (largest diameter <10 mm). This exam may be indicated as a low-morbidity diagnostic tool for finding pituitary microadenomas in Cushing disease that are not visualized by 1.5 Tesla magnetic resonance imaging.
Highlights
Cushing’s syndrome occurs from exposure to supra-physiological levels of glucocorticoids. 1-5 In childhood and adolescence, the most frequent clinical findings are: generalized obesity associated with growth retardation, and delayed bone age. 6-9 Other less specific manifestations are pubertal retardation, fatigue, acne, depression, hypertension and hirsutism. 6-9Stretch marks and a hunched back, which are characteristic in adulthood, are often absent
People with Cushing’s disease are recommended to have surgery, and the preoperative localization of the adenoma allows for greater surgical success.[1,2,3,4,5]
Magnetic resonance imaging (MRI) using 3 Tesla (RM 3T) technology offers a higher magnetic field, resulting in finer cuts, better image quality and a greater ability to differentiate between adenoma and normal pituitary tissue. 10-13 3T MRI has been studied with regard to the detection of small adenomas, like those present from Cushing’s Disease
Summary
Cushing’s syndrome occurs from exposure to supra-physiological levels of glucocorticoids. 1-5 In childhood and adolescence, the most frequent clinical findings are: generalized obesity associated with growth retardation, and delayed bone age. 6-9 Other less specific manifestations are pubertal retardation, fatigue, acne, depression, hypertension and hirsutism. 6-9Stretch marks and a hunched back, which are characteristic in adulthood, are often absent. 10-13 3T MRI has been studied with regard to the detection of small adenomas, like those present from Cushing’s Disease.
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