8319 Pituitary Apoplexy Leads to the Spontaneous Resolution of Hypercortisolism Secondary to Cushing Disease: A Clinical Case

• DOI: 10.1210/jendso/bvae163.1301
• Publication Date: 2024-10-05T20:29:02Z
• Authors: Nadia Sweis; Julienne Sanchez ...; Maria Fariduddin; Robert Michael Sa...; Daniel Joseph Toft; Sirimon Reutrakul
• Keywords: Cushing's disease; Pituitary apoplexy; Cushing Disease

Abstract Disclosure: N. Sweis: None. J. Sanchez Perez: M. Fariduddin: R.M. Sargis: D.J. Toft: S. Reutrakul: Background: Pituitary apoplexy is a potentially fatal condition involving the infarction or hemorrhage of pituitary gland. Rarely, it can occur in setting an ACTH-secreting adenoma. Clinical Case: A 27-year-old female with past medical history obesity, spontaneous miscarriages, and amenorrhea presented to ER acute onset frontal headache throbbing quality, associated nausea vomiting. The began two days prior, rapidly intensified, did not improve oral acetaminophen. CT head revealed enlarged gland, while neurovascular imaging showed no abnormalities. Her neurologic examination was normal. She denied visual changes, photophobia, neck rigidity, fevers, chills, recent infections. Furthermore, she endorsed weight gain about 40 pounds over year despite change dietary habits. This accompanied by amenorrhea, hair thinning, itchy comedonal acne, hirsutism, loss libido. physical remarkable for presence cushingoid features including violaceous abdominal striae, facial moon facies, dorsal fat pad, acanthosis nigricans around axillae. MRI without contrast sellar suprasellar macroadenoma measuring approximately 2.1x1.4x1.2 cm abutting optic chiasm. visualized lesion contained hemorrhagic products, suggesting apoplexy. Biochemical testing on admission included low morning plasma cortisol 6.5 ug/dL (ref. range: 6.7-22.6 ug/dL), 24-hour urine free 12.0 (<=45.0 ug/24 hour), elevated ACTH 145.0 pg/mL (7.2 - 63.3 pg/mL). A1c 5.8% (<5.7%). Serum levels prolactin, IGF1, GH, LH, FSH, TSH, Free T4, estradiol, total bioavailable testosterone were within normal limits. evaluated stimulation test, which level 1.2 at baseline, lower from prior. Cortisol adequately increased 19.6 22.6 ug/dL, 30 60 minutes after administration Cosyntropin 250 mcg, respectively (>=18 30-60 mins). time also decreased 76.6 pg/mL. patient therefore started steroid replacement therapy hydrocortisone later underwent transsphenoidal resection mass complications. Histopathological resected adenoma cells diffuse weak moderate staining, most consistent sparsely granulated corticotroph Conclusion: We report interesting case Cushing disease that spontaneously resolved Our underlines importance close monitoring such patients who may undergo period adrenal insufficiency hypercortisolism. Presentation: 6/3/2024