Journal
INTERNAL MEDICINE
Volume 45, Issue 21, Pages 1231-1235Publisher
JAPAN SOC INTERNAL MEDICINE
DOI: 10.2169/internalmedicine.45.1809
Keywords
pituitary incidentaloma; transsphenoidal surgery; adrenocorticotropic hormone (ACTH); cortisol
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Funding
- Ministry of Education, Culture, Sports, Science and Technology
- Ministry of Health, Labor and Welfare, Japan
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A 49-year-old woman with hypertension, obesity and impaired glucose tolerance (IGT) was admitted for evaluation of pituitary incidentaloma. Although she presented no Cushingoid feature, endocrine examination of hypothalamo-pituitary-adrenal (HPA) axis showed elevated basal plasma ACTH and cortisol levels, their lack of circadian rhythm, non-suppressibility to low-dose (1 mg) dexamethasone, and responsiveness to CRH, suggesting autonomous ACTH secretion from a pituitary tumor. She underwent transsphenoidal surgery, and was diagnosed as chromophobe adenoma with positive ACTH immunoreactivity. Postoperatively, her abnormal HPA axis was resolved, along with improvement of hypertension, obesity and IGT. Thus, her metabolic comorbidities are likely due to subclinical Cushing's disease.
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