Journal List > J Korean Soc Endocrinol > v.21(2) > 1063850

Kong, Kim, Kim, Nam, Park, Park, Kim, Moon, Hong, Ahn, and Kim: Reversible Pituitary Dysfunction in a Patient with Cushing's Syndrome due to Adrenal Adenoma

Abstract

A 45-year-old woman who complained of weight gain and irregular menstruation was diagnosed as having Cushing's syndrome due to a 3 cm sized left adrenal adenoma. She underwent left adrenalectomy, and she also underwent combined anterior pituitary tests before and 9 months after the surgery. The growth hormone and adrenocorticotropic hormone levels failed to respond to hypoglycemia before the surgery, but their responses recovered after the surgery. Cortisol and thyroid stimulating hormone failed to respond to hypoglycemia and thyrotropin releasing hormone (TRH) before the surgery, respectively, but these were improved after the surgery. Luteinizing hormone, follicle stimulating hormone, and prolactin adequately responded to gonadotropin-releasing hormone and TRH, respectively, before and after the surgery. However, the basal levels of these hormones were higher after adrenalectomy, suggesting that hypercortisolemia had a significant influence on all the pituitary hormones.

Figures and Tables

Fig. 1
Abdominal CT scan shows round mass on leftadrenal gland measured by approximately 3 cm in diameter.
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Fig. 2
Histopathologic findings. The adrenal cortical adenoma is well defined and partly capsulated and surrounded by compressed medullar (arrow) and atrophic cortical gland (H&E stain, ×40). The tumor is composed of variable cells showing vacuolated bright cells and eosinophilic dark cells (inset, H&E stain, ×400).
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Fig. 3
Insulin tolerance test. Time-course response of adrenocorticotropic hormone (ACTH) (A), cortisol (B), and growth hormone (GH) (C) concentrations to insulin injection was evaluated before and after the adrenal surgery.
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Fig. 4
Thyrotropin releasing hormone (TRH) loading test. Time-course responses of thyroid stimulating hormone (TSH) (A) and prolactin (B) to TRH (200 µg IV) were evaluated before and after the adrenal surgery.
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Fig. 5
Gonadotropin releasing hormone (GnRH) loading test. Time-course response of follicle stimulating hormone (FSH) (A) and luteinizing hormone (LH) (B) to GnRH (100 µg IV) injection was evaluated before and after the adrenal surgery.
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Table 1
Combined anterior pituitary test (before the surgery)
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IGF-1 322 kU/L, Estradiol 56.2 pmol/L, T3 0.92 nmol/dL, free T4 13.3 pmol/L.

ACTH, adrenocorticotropic hormone; GH, growth hormone; FSH, follicle stimulating hormone; LH, luteinizing hormone; TSH, thyroid stimulating hormone.

Table 2
Dexamethasone suppression test
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ACTH, adrenocorticotropic hormone; 17-OHCS, 17-hydroxycorticosteroid; 17-KS, 17-ketosteroids.

Table 3
Combined anterior pituitary test (after the surgery)
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IGF-1 379 kU/L, Estradiol 125.2 pmol/L, T3 1.58 nmol/L, free T4 11.3 pmol/L.

ACTH, adrenocorticotropic hormone; GH, growth hormone; FSH, follicle stimulating hormone; LH, luteinizing hormone; TSH, thyroid stimulating hormone.

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