Sparsely Granulated Corticotroph Pituitary Macroadenoma Presenting With Pituitary Apoplexy Resulting in Remission of Hypercortisolism

Tao Liu, MD; John P. Rossiter, MB, BCh, PhD; Robyn L. Houlden, MD; Sara Awad, MBBS, MHPE

AACE Clinical Case Reports (Jul 2022)

Sparsely Granulated Corticotroph Pituitary Macroadenoma Presenting With Pituitary Apoplexy Resulting in Remission of Hypercortisolism

Tao Liu, MD,
John P. Rossiter, MB, BCh, PhD,
Robyn L. Houlden, MD,
Sara Awad, MBBS, MHPE

Affiliations

Tao Liu, MD: Department of Medicine, Queen’s University, Kingston, Ontario, Canada; Division of Endocrinology and Metabolism, Queen’s University, Kingston, Ontario, Canada; Address correspondence to Dr Tao Liu, Division of Endocrinology and Metabolism, Queen’s University, C3-008-0, Hotel Dieu Hospital 166 Brock St, Kingston, Ontario, Canada.
John P. Rossiter, MB, BCh, PhD: Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada
Robyn L. Houlden, MD: Department of Medicine, Queen’s University, Kingston, Ontario, Canada; Division of Endocrinology and Metabolism, Queen’s University, Kingston, Ontario, Canada
Sara Awad, MBBS, MHPE: Department of Medicine, Queen’s University, Kingston, Ontario, Canada; Division of Endocrinology and Metabolism, Queen’s University, Kingston, Ontario, Canada

Journal volume & issue: Vol. 8, no. 4
pp. 166 – 170

Abstract

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Objective: Pituitary corticotroph macroadenomas, which account for 7% to 23% of corticotroph adenomas, rarely present with apoplexy. This report aimed to describe a patient with a sparsely granulated corticotroph tumor (SGCT) presenting with apoplexy and remission of hypercortisolism. Case Report: A 33-year-old male patient presented via ambulance with sudden onset of severe headache and nausea/vomiting. Physical examination revealed bitemporal hemianopsia, diplopia from right-sided third cranial nerve palsy, abdominal striae, facial plethora, and dorsal and supraclavicular fat pads. Magnetic resonance imaging demonstrated a 3.2-cm mass arising from the sella turcica with hemorrhage compressing the optic chiasm, extension into the sphenoid sinus and cavernous sinus. Initial investigations revealed a plasma cortisol level of 64.08 (reference range [RR], 2.36-17.05) mcg/dL. He underwent emergent transsphenoidal surgery. Pathology was diagnostic of SGCT. Postoperatively, the following laboratory findings were found: (1) cortisol level, <1.8 ug/dL (RR, 2.4-17); (2) adrenocorticotropic hormone level, 36 pg/mL (RR, 0-81); (3) thyroid-stimulating hormone level, 0.07 uIU/mL (RR, 0.36-3.74); (4) free thyroxine level, 1 ng/dL (RR, 0.8-1.5); (5) luteinizing hormone level, <1 mIU/mL (RR, 1-12); (6) follicle-stimulating hormone level, 1 mIU/mL (RR, 1-12); and (7) testosterone level, 28.8 ng/dL (RR, 219.2-905.6), with ongoing requirement for hydrocortisone, levothyroxine, testosterone replacement, and continued follow-up. Discussion: Corticotroph adenomas are divided into densely granulated, sparsely granulated, and Crooke cell tumors. Sparsely granulated pattern is associated with a larger tumor size and decreased remission rate after surgery. Conclusion: This report illustrates a rare case of hypercortisolism remission due to apoplexy of an SGCT with subsequent central adrenal insufficiency, hypothyroidism, and hypogonadism.

Published in AACE Clinical Case Reports

ISSN: 2376-0605 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the endocrine glands. Clinical endocrinology
Website: https://www.journals.elsevier.com/aace-clinical-case-reports

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