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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
Case Report
Journal of Korean Society of Endocrinology

Journal of Korean Society of Endocrinology 2006; 21(2): 146-152.

Published online: 20 April 2006

DOI: https://doi.org/10.3803/jkes.2006.21.2.146

Reversible Pituitary Dysfunction in a Patient with Cushing's Syndrome due to Adrenal Adenoma

Jee Hyun Kong, Kyung Wook Kim, Hei Jin Kim, Ji Sun Nam, Jin A Park, Jong Sook Park, Chul Sik Kim, Byung Soo Moon, Soon Won Hong1, Chul Woo Ahn, Kyung Rae Kim

Department of Internal Medicine, Yonsei University College of Medicine, Korea.

1Department of Pathology, Yonsei University College of Medicine, Korea.

Received 14 September 2005       Accepted 7 January 2006

Copyright © 2006 Korean Endocrine Society

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.

Keywords: Cushing's syndrome, Hypopituitarism, Growth hormone, Thyroid stimulating hormone, Hypercortisolism

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)
jkse-21-146-i001

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
jkse-21-146-i002

ACTH, adrenocorticotropic hormone; 17-OHCS, 17-hydroxycorticosteroid; 17-KS, 17-ketosteroids.

Table 3
Combined anterior pituitary test (after the surgery)
jkse-21-146-i003

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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