Ectopic Corticotroph Adenoma in the Cavernous Sinus: Case Report

Ectopic Corticotroph Adenoma in the Cavernous Sinus: Case Report AbstractOBJECTIVEAdrenocorticotropin (ACTH)-secreting pituitary adenomas causing Cushing's disease are often difficult to identify because of their variable locations and their small size. This report presents histological evidence of an ectopic ACTH-secreting adenoma located entirely within the cavernous sinus.METHODSA 62-year-old woman presented with central obesity, hypertension, and osteoporosis. Endocrinological evaluation suggested the presence of an ACTH-secreting pituitary adenoma; however, imaging studies, including dynamic magnetic resonance imaging, did not reveal any visible lesions in the pituitary gland. Bilateral cavernous sinus sampling demonstrated a large central/peripheral ACTH gradient, with a right/left ACTH gradient. The patient was treated as having pituitary- dependent Cushing's disease, until she died suddenly as a result of acute respiratory failure.RESULTSIn a postmortem histological examination, an ACTH-secreting adenoma was found in the right cavernous sinus, which was completely surrounded by dura mater and had no direct connection with the pituitary gland.CONCLUSIONAlthough they are rare, such adenomas located in the cavernous sinus should be recognized as one of the reasons for inaccurate cavernous sinus sampling and the failure of transsphenoidal surgery for patients with ACTH-dependent Cushing's syndrome. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Ectopic Corticotroph Adenoma in the Cavernous Sinus: Case Report

Ectopic Corticotroph Adenoma in the Cavernous Sinus: Case Report

914 Sanno et al. ment. If evidence of an ACTH-secretin • s Ectopic Corticotroph Adenoma in the adenoma is convincing but the existence of a tumor cannot be confirmed using Cavernous Sinus: Case Report imaging studies or during surgery, a hem ihypophysectom y or total hypophy- sectomy is sometimes performed. However, it is known that there maybe N a o k o S a n n o , M . D . , P h .D ., S h ig e y u k i T a h a ra , M . D . , anatomic reasons for the failure of hvpo Y o ic h i Y o s h id a , M . D . , H ir o y u k i O n o s e , M . D . , physectomies in patients with Cushing's disease (12, 14, 25, 26). In this report, w e Ic h iji W a k a b a y a s h i, M . D . , D . M . S c . , demonstrate a pitfall of cavernous sinus A k ir a T e ra m o to , M . D . , D . M . S c . sam pling in such a case, with an ACTH- Departments of Neurosurgery and Internal Medicine, Nippon Medical School, Tokyo, lapan secreting ectopic adenoma located entirely within the cavernous sinus. O BJEC T IV E A N D IM PO R T A N C E: Adrenocorticotropin (ACTH)-secreting pi­ CASE REPO RT tuitary adenomas causing Cushing's disease are often difficult to identify A 62-year-old woman had a 3-year because of their variable locations and their small size. This report history of truncal obesity, a moon face,a presents histological evidence of an ectopic ACTH-secreting adenoma buffalo hump, and diagnosed hyperten­ located entirely within the cavernous sinus. sion and diabetes mellitus. She had expe­ C LIN IC A L PRESEN TA TIO N : A 62-year-old woman presented with central rienced hypertensive intracranial hemor­ obesity, hypertension, and osteoporosis. Endocrinological evaluation sug­ rhaging 2 years earlier, which resulted in gested the presence of an ACTH-secreting pituitary adenoma; however, right-sided motor weakness. At admis­ sion to our institute, she presented w ith imaging studies, including dynamic magnetic resonance imaging, did not typical cushingoid...
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199910000-00041
Publisher site
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Abstract

AbstractOBJECTIVEAdrenocorticotropin (ACTH)-secreting pituitary adenomas causing Cushing's disease are often difficult to identify because of their variable locations and their small size. This report presents histological evidence of an ectopic ACTH-secreting adenoma located entirely within the cavernous sinus.METHODSA 62-year-old woman presented with central obesity, hypertension, and osteoporosis. Endocrinological evaluation suggested the presence of an ACTH-secreting pituitary adenoma; however, imaging studies, including dynamic magnetic resonance imaging, did not reveal any visible lesions in the pituitary gland. Bilateral cavernous sinus sampling demonstrated a large central/peripheral ACTH gradient, with a right/left ACTH gradient. The patient was treated as having pituitary- dependent Cushing's disease, until she died suddenly as a result of acute respiratory failure.RESULTSIn a postmortem histological examination, an ACTH-secreting adenoma was found in the right cavernous sinus, which was completely surrounded by dura mater and had no direct connection with the pituitary gland.CONCLUSIONAlthough they are rare, such adenomas located in the cavernous sinus should be recognized as one of the reasons for inaccurate cavernous sinus sampling and the failure of transsphenoidal surgery for patients with ACTH-dependent Cushing's syndrome.

Journal

NeurosurgeryOxford University Press

Published: Oct 1, 1999

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