Complex treatment of invasive corticotropic pituitary macroadenoma - Case report
DOI:
https://doi.org/10.12775/JEHS.2022.12.07.033Keywords
macroadenoma, Cushing diseas, hypercortisolemiaAbstract
Introduction: Cushing's disease is a hypercortisolemic state caused by the excess secretion of corticotropin by the pituitary adenoma. Cushing's disease is diagnosed on the basis of clinical and laboratory signs of hypercortisolemia and the presence of an MRI pituitary adenoma. Pituitary surgery represents the first-line therapy, but it is non-curative in one third of patients, requiring additional treatments. Second-line treatments include pharmacotherapy, pituitary radiotherapy and bilateral adrenalectomy.
Case report: A 57-year-old patient with clinical symptoms of hypercortisolemia was admitted to the Endocrinology Clinic due to dizziness and headache. Laboratory tests and MRI confirmed Cushing's disease caused by invasive pituitary macroadenoma. The tumor was not completely resected through the sphenoid sinus. Disease symptoms were remitted and hormone levels were stabilized. After 2 years, the underlying disease was relapsed. A second tumor removal operation was performed. The tumor was incompletely removed. The disease has progressed.. The patient was referred for stereotaxic CyberKnife radiotherapy.
Conclusion: Cushing's disease should be diagnosed and treated in a specialized endocrinology center, and the success of treatment depends on a multidisciplinary team of physicians consisting of an endocrinologist, neurosurgeon and neuroradiologist.About 50% of untreated patients die within 5 years of the disease due to complications of hypercortisolemia. Surgical treatment is effective in the case of microadenomas, while in the case of macroadenomas, it may turn out to be ineffective when the tumor is highly invasive. If subsequent surgeries are unsuccessful, treatment with radiotherapy or pharmacotherapy should be given.
References
Bolanowski M. Guzy przysadki (2012) W: A. Milewicz (red.) Endokrynologia Kliniczna tom 2. Praca zbiorowa (s. 148-150)Wrocław: PTE
Brue T., Castinetti F. (2016) The risks of overlooking the diagnosis of secreting pituitary adenomas. J. Rare Dis. 2016; 11: 135. doi: 10.1186/s13023-016-0516-x
Buliman A., Tataranu LG., Paun DL., Mirica A., Dumitrache C. (2016). Cushing’s disease: a multidisciplinary overview of the clinical features, diagnosis, and treatment. J. Med. Life Jan-Mar; 9(1): 12-18
Burns K., Christie-David D., Gunton J. (2016) Fluconazole in the treatment of Cushing's disease Endocrinol Diabetes Metab 2016: 150115 doi: 10.1530/EDM-15-0115.
Castinetti F., Morange I., Conte-Devolx B., Brue T. (2012). Cushing’s disease Orphanet J. Rare Dis. 201;2 7:41 Online 2012 Jun 18 doi: 10.1186/1750-1172-7-41
Cieszyński Ł., Berendt-Obołończyk M., Szulc M., Sworczak K. (2016) Zespół Cushinga w przebiegu ektopowego wydzielania ACTH W: Endokrynologia Polska nr.4 tom 67 (s. 465-471). WM Media
doi: 10.1530/EDM-15-0115
Hopkins RL, Leinung MC. (2005) Exogenous Cushing's syndrome and glucocorticoid withdrawal. Endocrinol Metab Clin North Am. 34:371–384. Ix
Juszczak A., Grossman A. (2014) Postępowanie w chorobie Cushinga – od testu diagnostycznego do leczenia. Endokrynologia Polska Tom 65 zeszyt edukacyjny I s. 2-12
Karczewska-Kupczewska M., Myśliwiec J., Górska M. (2006) Aktualne poglądy na diagnostykę zespołu Cushinga. Endokrynologia Polska. Tom 57 Numer 5 (s.546-558) WM Media.
Pivonello R., Ferrigno R., De Martino M., Simeoli C., DI Paola N., Pivonello C., Barba L., Negri M., De Angelis C., Colao A. Medical Treatment of Cushing's Disease: An Overview of the Current and Recent Clinical Trials. Front Endocrinolm(Lausanne). 2020; 11: 648. Published online 2020 Dec 8. doi: 10.3389/fendo.2020.00648
Lonser RR., Nieman L., Oldfiel E. (2017) Cushing's disease: pathobiology, diagnosis, and management. JNS Journal of Neurosurgery Volume 126 Issue 2 online 2017: https://doi.org/10.3171/2016.1.JNS152119
Maksymowicz M., Olszewski W. (2010) Przydatność mikroskopii elektronowej w diagnostyce gruczolaków przysadki. Folia Medica Lodziensia 37/1: 151-173
Nishioka H., Yamada S. (2019) Cushing’s Disease. J Clinic Med. 2019 Nov;8(11):1951 doi: 10.3390/jcm8111951
Sworczak K., Siekierska-Hellmann M., Obołończyk Ł. Kortykotropinoma-ACTH – zależny zespół Cushinga (2012) W: A. Milewicz (red.) Endokrynologia Kliniczna tom 2. Praca zbiorowa (s.163-167). Wrocław: PTE
Tritos N.A., Biller B.M.K. (2019) Current management of Cushing's disease JIM Volume 286, Issue 5 s.526-541
Kairys N., Schwell A., Cushing Disease Treasure Island (FL): StatPearls Publishing; 2022 Jan
Witek P., Zieliński G., Szamotulska K., Maksymowicz M., Kamiński G. (2016). Clinicopathological predictive factors in early remission of corticotroph pituitary macroadenomas in a tertiary referral centre. European Journal of Endocrinology 174:4, s 539-549
Chaudhry H.S.,.Singh G., Cushing Syndrome Treasure Island (FL): StatPearls Publishing; 2022 Jan
Zgliczyński W., Witek P., Zdunowski P. (2011). Guzy przysadki W: W. Zgliczyński (red.), Endokrynologia część 1 Wielka Interna. Praca zbiorowa (s. 65-91) Warszawa 2011 Medical Tribune
Ye Chen V., Akagami R., Perioperative Quality of Life in Cushing's Disease. Can J Neurol Sci 2017 Jan;44(1):69-77. doi: 10.1017/cjn.2016.295.
Yamamoto M., Nakao T., Ogawa W., Fukuoka H., Aggressive Cushing’s Disease: Molecular Pathology and Its Therapeutic Approach. Front Endocrinol (Lausanne). 2021; 12: 650791. doi: 10.3389/fendo.2021.650791
Nieman L.K., Biller B.M.K., Findling J.W., Murad M.H., Newell-Price J., Savage M.O., Tabarin A. Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab. 2015 Aug; 100(8): 2807–2831.. doi: 10.1210/jc.2015-1818
Hinojosa-Amaya J.M., Varlamov E.V., McCartney S., Fleseriu M. Hypercortisolemia Recurrence in Cushing's Disease; a Diagnostic Challenge Front Endocrinol (Lausanne). 2019; 10: 740. doi: 10.3389/fendo.2019.00740
Tritos,N.A, Biller B.M.K. Current management of Cushing's disease. Journal of Internal Medicine https://doi.org/10.1111/joim.12975
Braun L.T., Rubinstein G., Zopp S., Vogel F., Schmid-Tannwald C., Escuder M.P., Honegger J., Ladurner R., Reincke M., Recurrence after pituitary surgery in adult Cushing’s disease: a systematic review on diagnosis and treatment. Endocrine. 2020; 70(2): 218–231. . doi: 10.1007/s12020-020-02432-z
Masui K., Wajima D., Aketa S., Nishimura F., Efficacy of Endoscopic Transsphenoidal Surgery for Cushing's Disease: Case Series and Review of the Literature Year : 2020 | Volume : 68 | Issue : 2 | Page : 403-406DOI: 10.4103/0028-3886.284363
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Michał Obel, Emilia Nowicka, Piotr Dzikowski, Zofia Pietrzak, Martyna Stefaniak, Ewa Obel
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 313
Number of citations: 0