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Pituitary Tumor Hemorrhage in Cushing Disease
- Leilani B. Mercado-Asis, MD, PhD;
- Edward H. Oldfield, MD; and
- Gordon B. Cutler, MD
- From the National Institutes of Health, Bethesda, Maryland. Requests for Reprints: Leilani B. Mercado-Asis, MD, PhD, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, 10N262, Bethesda, MD 20892.
Spontaneous pituitary hemorrhage and necrosis (pituitary apoplexy) have been reported to occur in 9.5% to 16.6% of pituitary tumors [1-3]. However, pituitary apoplexy rarely develops in patients with Cushing disease. The clinical presentation of pituitary hemorrhage varies from no symptoms to a neurosurgical emergency in which structures in the sellar and parasellar regions are compressed [1-3]. Transient hypopituitarism is common after pituitary apoplexy. Pituitary function may improve either spontaneously [4, 5] or after surgical decompression [6, 7].
We describe two patients who developed adrenal insufficiency and subsequently Cushing disease after hemorrhage into adrenocorticotropin hormone (ACTH)-secreting pituitary microadenomas. To our knowledge, this has not been reported previously.
Case Reports
Patient 1, a 23-year-old white woman, developed the Cushing syndrome in 1984. She was first evaluated at the National Institutes of Health (NIH) in 1985. During the initial endocrine assessment, she had cushingoid features but low basal 0800-h plasma cortisol levels (range, <11 to 88 nmol/L; normal range, …
