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Diagnosis and Treatment > Signs and Symptoms

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Sharmin Jahan Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh

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M A Hasanat Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh

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Tahseen Mahmood Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh

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Shahed Morshed Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh

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Raziul Haq Department of Neurosurgery, Dhaka Medical College and Hospital (DMCH), Dhaka, Bangladesh

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Md Fariduddin Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh

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Summary

Silent corticotroph adenoma (SCA) is an unusual type of nonfunctioning pituitary adenoma (NFA) that is silent both clinically and biochemically and can only be recognized by positive immunostaining for ACTH. Under rare circumstances, it can transform into hormonally active disease presenting with severe Cushing syndrome. It might often produce diagnostic dilemma with difficult management issue if not thoroughly investigated and subtyped accordingly following surgery. Here, we present a 21-year-old male who initially underwent pituitary adenomectomy for presumed NFA with compressive symptoms. However, he developed recurrent and invasive macroadenoma with severe clinical as well as biochemical hypercortisolism during post-surgical follow-up. Repeat pituitary surgery was carried out urgently as there was significant optic chiasmal compression. Immunohistochemical analysis of the tumor tissue obtained on repeat surgery proved it to be an aggressive corticotroph adenoma. Though not cured, he showed marked clinical and biochemical improvement in the immediate postoperative period. Anticipating recurrence from the residual tumor, we referred him for cyber knife radio surgery.

Learning points:

  • Pituitary NFA commonly present with compressive symptoms such as headache and blurred vision.

  • Post-surgical development of Cushing syndrome in such a case could be either drug induced or endogenous.

  • In the presence of recurrent pituitary tumor, ACTH-dependent Cushing syndrome indicates CD.

  • Rarely a SCA presenting initially as NFA can transform into an active corticotroph adenoma.

  • Immunohistochemical marker for ACTH in the resected tumor confirms the diagnosis.

Taxonomy:
Clinical Overview, Gland/Organ, Pituitary, Topic, Pituitary, Hormone, ACTH, Cortisol, FSH, Prolactin, Testosterone, Condition/ Syndrome, Corticotrophic adenoma, Cushing's disease, Cushing's syndrome, Hypogonadotrophic hypogonadism, Non-functioning pituitary adenoma, Patient Demographics, Age, Adolescent/young adult, Gender, Male, Ethnicity, Asian - Bangladeshi, Country of Treatment, Bangladesh, Diagnosis and Treatment, Signs and Symptoms, Acanthosis nigricans, Central obesity, Dyslipidaemia, Facial plethora, Facies - moon, Hypogonadism, Leukocytosis, Obesity, Striae, Supraclavicular fat pads, Visual disturbance, Visual field defect, Weight gain, Investigation, ACTH, Blood pressure, Cortisol (plasma), Cortisol, free (24-hour urine), CT scan, Dexamethasone suppression (high dose), Dexamethasone suppression (low dose), FSH, Histopathology, Immunohistochemistry, Immunostaining, Liver function, MRI, Prolactin, Testosterone, Intervention, Gamma knife radiosurgery, Radiotherapy, Resection of tumour, Transsphenoidal surgery, Medication, Dexamethasone, Glucocorticoids, Related Disciplines, Ophthalmology, Pathology, Surgery, Publication Details, Case Report Type, Error in diagnosis/pitfalls and caveats
DOI:
https://doi.org/10.1530/EDM-19-0046
Volume/Issue:
Volume 2019: Issue 1
Open access