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Lee, Rhee, Chon, Oh, Woo, Kim, Kim, Kim, Lee, and Jeon: A Case of Cushing's Disease due to Pituitary Microadenoma Combined with Primary Empty Sella Syndrome
Case Report
Journal of Korean Endocrine Society

Journal of Korean Endocrine Society 2006; 21(6): 567-571.

Published online: 20 December 2006

DOI: https://doi.org/10.3803/jkes.2006.21.6.567

A Case of Cushing's Disease due to Pituitary Microadenoma Combined with Primary Empty Sella Syndrome

Yun Jung Lee1, Sangyoul Rhee1, 2, Suk Chon1, 2, Seungjoon Oh1, 2, Jeong-Taek Woo1, 2, Sung-Woon Kim1, 2, Jin-Woo Kim1, 2, Young-Seol Kim1, 2, Byung Wook Lee3, Jung Won Jeon4

1Department of Endocrinology and Metabolism, College of Medicine Kyung-Hee University, Korea.

2Department of Endocrine Research Institute, College of Medicine Kyung-Hee University, Korea.

3Department of Internal Medicine, Dong Su Won General Hospital, Korea.

4Department of Internal Medicine, Heemalkeun hospital Incheon, Korea.

Received 1 August 2006       Accepted 4 September 2006

Copyright © 2006 Korean Endocrine Society

Abstract

An empty sella is defined as a sella which, regardless of its size, is completely or partly filled with cerebrospinal fluid. The endocrine function of primary empty sella syndrome is usually normal, but sometimes this syndrome is associated with complete or partial pituitary insufficiency and rarely hypersecretion of pituitary hormone. Primary empty sella syndrome combined with Cushing's disease has rarely been reported. A 45-years-old woman presented with cushingoid feature. Her urinary cortisol and 17-hydroxycorticosteroid excretion were increased. The results of endocrine function testing were suggestive of Cushing's disease. Sella MRI showed of partially empty sella and pituitary microadenoma. The pituitary microadenoma was removed by the trans-sphenoidal approach. We report here on this case together with a review of the literature.

Keywords: Cushing's disease, Empty sella syndrome, Pituitary microadenoma

Figures and Tables

Fig. 1
MRI of pituitary gland. A. Coronal T1-weighted MR scan shows a partially empty sella; B. Coronal post contrast T1-weighted MR scan shows a tiny hypointense lesion within the enhancing pituitary gland (5 × 4.9 mm in size).
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Fig. 2
Histology of the resected pituitary mass. Microscopic appearance of (H&E stain, × 100) panel shows solid sheet of neoplastic cells with intervening vascular channels. The indivisual cell are round to oval nucleus with acidophilic and clear cytoplasm.
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Table 1
Standard low and high dose dexamethasone suppression test
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*Values at time 48 hours after 0.5 mg every 6 hours (2 mg/day) on days 1 and 2.

†Values at time 96 hours after 2 mg every 6 hours (8 mg/day) on days 3 and 4.

17-OHCS, 17-hydroxycorticosteroid; ACTH, adrenocorticotropic hormone; UC, urinary cortisol.

Table 2
Result of adrenocorticotropic hormone (ACTH) level during inferior petrosal sinus sampling*
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*Studies were performed after the intravenous administration at 0 minute of 100 µg corticotrophin releasing hormone (CRH), and sampled for ACTH at 2, 5 and 10 minutes in both petrosal and peripheral vein. But, basal Lt. petrosal ACTH and peripheral ACTH at 2, 5 minutes samples could not measured.

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