A rare clinical case of giant pituitary ACTH adenoma

#3824

Introduction: Cushing's disease is a neuroendocrine disease that is associated with ACTH-secreting pituitary microadenomas whereas macro- and giant adenomas are less common.

Aim(s): We want to present a rare clinical case of giant corticotropinoma.

Materials and methods: Female patient R., since age 43 (2014) was supervised by an endocrinologist for type 2 diabetes mellitus and BMI 29 kg/m2. At age 50, in February 2021, she noted a worsening of vision and dizziness. MRI showed a pituitary adenoma 4.2x4.0x3.9 cm in size with a chiasm compression. A neurosurgeon recommended a hormonal investigation, but it took a long period. In April 2021 salivary cortisol 11pm 120 pmol/l (<9.5 pmol/l), in November 2021 ACTH >28.4 pmol/l (1.6-13.9). In December 2021 the patient’s condition was worsened: She complained about muscle weakness and severe swelling of the lower extremities, purple striae, glycemia was out of control. In April 2022 according to laboratory results ACTH 64.2 pmol/l (1.6-13.9), serum cortisol 8am 1809 nmol/l (185-624), HbAc1 9.3%, K+ 2.6 mmol/l (4.0-5.2). Cushing's disease was diagnosed, a transnasal adenomectomy was performed.

Conference:

Presenting Author:

Authors: Lastovkina A, Ilovaiskaya I, Komerdus I, Motrenko A, Zakharova P,

Keywords: Cushing's disease, giant corticotropinoma, hypercortisolism,