Pituitary microadenoma-Cushing disease

Case contributed by Dr Dalia Ibrahim

Presentation

Presented with Cushing disease, elevated cortisol & ACTH levels

Patient Data

Age: 25-year-old
Gender: Female

Right-sided 4-mm low signal intensity lesion abuts medial dural reflection of cavernous sinus. Left half of gland is normal. There's no abnormality of the stalk or remodeling of the sellar floor. There is no evidence of invasion of the cavernous sinuses.

Case Discussion

Cushing syndrome is caused by excessive amounts of hydrocortisone and corticosterone released from the adrenal cortex.

Causes: 1

  • adrenal hyperplasia causes 70% of noniatrogenic Cushing syndrome, the hyperplasia is caused by 90% by "Pituitary microadenoma" causing hypersecretion of ACTH
  • adrenal adenoma causes 20% of Cushing syndrome
  • adrenal carcinoma cause 10%of Cushing syndrome

Pituitary microadenoma: <10mm in diamter 2

Dynamic contrast-enhanced thin-section T1 WI: it enhances but less rapidly than surrounding normal gland. 2

Differential diagnosis:2

  • nonneoplastic cyst  
  • incidental non functioning microadenoma
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Case information

rID: 42079
Case created: 5th Jan 2016
Last edited: 6th Feb 2017
Inclusion in quiz mode: Included

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