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Different imaging characteristics of concurrent pituitary adenomas in a patient with Cushing's disease
- Source :
- Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 22(5)
- Publication Year :
- 2015
-
Abstract
- We report a patient with Cushing’s disease (CD) and two pituitary adenomas that demonstrated different imaging characteristics and therefore suggest an alternative imaging strategy for these patients. A 42-year-old woman presented with signs and symptoms of CD. Biochemical evaluation confirmed hypercortisolemia and suggested CD. On pituitary MRI with spoiled gradient recalled acquisition in the steady-state and T1-weighted spin echo protocols, a 5 mm hypoenhancing region typical for a pituitary adenoma was identified on the left. However, after surgical resection the patient remained hypercortisolemic and pathology revealed a nonfunctional adenoma. At early repeat surgical exploration a 10 mm adenoma was found in the right side of the gland. Postoperatively the patient became hypocortisolemic and pathology demonstrated an adrenocorticotropic hormone (ACTH)-staining adenoma. On review of the initial MRI this tumor corresponded to a region of contrast retention best visualized on delayed fluid attenuated inversion recovery (FLAIR) imaging. While the incidentaloma in this case demonstrated classical imaging characteristics of a pituitary adenoma the larger ACTH-secreting tumor was best appreciated by contrast retention. This suggests a role for delayed postcontrast FLAIR imaging in the preoperative evaluation of CD. ACTH-secreting tumors causing CD cause significant morbidity. Due to their small size, a pituitary adenoma is frequently not identified on imaging despite endocrinologic testing suggesting CD. Regardless of improvements in MRI, many tumors are only identified at surgical exploration.
- Subjects :
- Adenoma
Adult
Pathology
medicine.medical_specialty
medicine.medical_treatment
Fluid-attenuated inversion recovery
Pituitary neoplasm
Article
Pituitary adenoma
Physiology (medical)
Medicine
Humans
Pituitary Neoplasms
Pituitary ACTH Hypersecretion
Transsphenoidal surgery
business.industry
Incidentaloma
Pituitary ACTH hypersecretion
General Medicine
Cushing's disease
medicine.disease
Magnetic Resonance Imaging
Neurology
Pituitary Gland
Mental Recall
Surgery
Female
Neurology (clinical)
business
Subjects
Details
- ISSN :
- 15322653
- Volume :
- 22
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
- Accession number :
- edsair.doi.dedup.....66e57d7de972aa113ead8efd43d46177