<p>Cushing’s Disease Caused by a Pituitary Microadenoma Coexistent with a Meningioma: A Case Report and Literature Review</p>

Abstract

Cushing's disease (CD), also known as adrenocorticotropic hormone (ACTH)dependent pituitary Cushing's syndrome, is a rare and serious chronic endocrine disease that is usually caused by a pituitary adenoma (especially a pituitary microadenoma). Meningioma is the most common type of primary intracranial tumor and is usually benign. The patient in this case report presented with CD coexisting with pituitary microadenoma and meningioma, which is an extremely rare comorbidity. The pathogenesis of CD associated with meningioma remains unclear. Here, we describe the case of bilateral lower extremity edema, lower limb pain, abdominal purplish striae, and abdominal distension for 9 months in a 47-year-old woman. Two years ago, the patient underwent a hysterectomy at a local hospital for hysteromyoma. She had no previous radiotherapeutic treatment or other medical history. Magnetic resonance imaging of her head revealed a sellar lesion (7.8 mm × 6.4 mm) and a spherical mass (3.0 cm × 3.0 cm) in the right frontal convexity. Her level of serum adrenocorticotropic hormone (ACTH) was 169 pg/mL, and her cortisol levels were 933 nmol/mL and 778 nmol/mL at 8 am and 4 pm, respectively. Preoperatively, she was diagnosed with ACTH-secreting pituitary microadenoma and meningioma. Excision of the meningioma was performed through a craniotomy, while an endoscopic endonasal transsphenoidal approach was used to remove the pituitary adenoma. Meningioma and pituitary adenoma were confirmed by postoperative pathology. On the basis of this unusual case, the relevant literature was reviewed to illustrate the diagnosis and treatment of Cushing's disease and to explore the pathogenesis of pituitary adenoma associated with meningioma.

Cushing’s Syndrome Secondary to Steroid Abuse

“…ACTH secreting pituitary adenomas though very rare (incidence of 1-2 per million) are responsible for 70 % of all endogenous causes of Cushing's syndrome. 11,18 However our patient's Brain MRI was normal. Our patient developed Cushing's syndrome secondary to oral corticosteroid-prednisolone abuse.…”

Assessment of the Pituitary Gland by MRI in Patients with Different Prolactin Levels in Hail Region

“…The results showed that the largest percentage according to Lab Results was in favor of High with a rate of 86 and a percentage of (84.30%), followed by Low with a rate of 13 and a percentage of (12.70 %), and followed by normal with a rate of 3 and a percentage of (2.90 %) Microadenoma is a benign tumor that originates in the pituitary gland, a pea-sized organ behind the eyes that controls growth, development, metabolism, and reproduction. Microadenomas can be functional (producing hormones) or nonfunctional (not producing hormones) [15].…”

endocrine background of meningioma carcinogenesis

“…The subject of impairments in ACTH-cortisol axis in meningioma patients was not under particular scientific consideration yet. This topic in scientific literature is usually considered in context of meningioma and pituitary adenoma coexistence -which may result with Cushing disease [10]. On the other hand, rapid growth of meningioma, may result up with hypoglycemia [11].…”