Reversible Pituitary Dysfunction in a Patient with Cushing's Syndrome Discovered as Adrenal Incidentaloma

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  • INAGAKI Kenichi
    Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry
  • OTSUKA Fumio
    Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry
  • MIYOSHI Tomoko
    Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry
  • WATANABE Naomi
    Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry
  • SUZUKI Jiro
    Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry
  • OGURA Toshio
    Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry
  • MAKINO Hirofumi
    Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry

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We report a 45-year-old woman with Cushing's syndrome showing reversible pituitary dysfunction. Left adrenal tumor was incidentally discovered by a screening examination of abdominal computed tomography. Although this patient lacked typical Cushingoid features except hypertension and leg edema, endocrine examinations revealed moderate suppression of plasma ACTH (~6.3 pg/ml) with relatively high levels of serum cortisol (~22.9 μg/dl) without normal circadian rhythm. Plasma ACTH failed to respond to either CRH or metyrapone, and dexamethasone failed to suppress her daily steroid production. Surgical removal of left adrenocortical adenoma and 6-month replacement of hydrocortisone have ameliorated both ACTH and cortisol responses to CRH loading test. Postoperative responses of TSH and GH to TRH and GRH, respectively, were two fold higher than the preoperative levels. In contrast, basal and TRH-induced levels of serum PRL were decreased after surgery although both the basal and stimulated PRL levels were markedly high before surgery. In addition, gonadotropin response to GnRH examined in the same ovarian cycle was decreased in accordance with an increase in serum estradiol and progesterone levels after surgery. Improvement of hypercortisolemia even in a moderate case of Cushing's syndrome not only ameliorates hypertension, obesity and glucose intolerance, but also restores the accompanying dysfunctions of anterior pituitary, suggesting the clinical importance of early discovery and treatment of functioning adrenocortical incidentalomas.<br>

収録刊行物

  • Endocrine Journal

    Endocrine Journal 51 (2), 201-206, 2004

    一般社団法人 日本内分泌学会

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