Unilateral laparoscopic adrenalectomy following partial transsphenoidal adenomectomy of pituitary macroadenoma - life-saving procedure in a patient with ACTH-dependent Cushing's syndrome

Endokrynologia Polska
Urszula AmbroziakTomasz Bednarczuk

Abstract

Cushing's disease is the most common cause of endogenous hypercortisolemia, in 90% of cases due to microadenoma. Macroadenoma can lead to atypical hormonal test results and complete removal of the tumour is unlikely. A 77-year-old woman with diabetes and hypertension was admitted because of fatigue, proximal muscles weakness, lower extremities oedema, and worsening of glycaemic and hypertension control. Physical examination revealed central obesity, 'moon'-like face, supraclavicular pads, proximal muscle atrophy, and skin hyperpigmentation. Biochemical and hormonal results were as follows: K 2.3 mmol/L (3.6-5), cortisol 8.00 86 μg/dL (6.2-19.4) 23.00 76 μg/dL, ACTH 8.00 194 pg/mL (7.2-63.3) 23.00 200 pg/mL, DHEAS 330 μg/dL (12-154). CRH stimulation test showed lack of ACTH stimulation > 35%, overnight high dose DST revealed no suppression of cortisol. Chest and abdominal CT as well as somatostatin receptor scan didn't show ectopic tumour responsible for ACTH oversecretion. MRI revealed a pituitary macroadenoma (28 × 20 × 17 mm) extending towards the left cavernous sinus. After partial transsphenoidal adenomectomy, serum cortisol of 40 μg/dL was obtained. The patient's condition was still very poor, so unilateral adrenalectomy w...Continue Reading

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