Treatment-resistant Cushing disease and acromegaly in a young woman: A case of functional pituitary macroadenoma

Abstract

Cushing disease and acromegaly are common endocrine disorders caused by excessive cortisol and growth hormone production, respectively. Both conditions can co-occur due to functioning pituitary adenomas, which are typically benign pituitary gland tumors. This report discusses a 30-year-old woman with hyperpituitarism leading to treatment-resistant Cushing disease and acromegaly caused by a functional pituitary macroadenoma. A 30-year-old woman presented with a history of excessive weight gain, facial puffiness, fatigue, persistent headaches, and visual disturbances. Clinical examination revealed features consistent with Cushing disease and acromegaly, including a moon face, central obesity, and large hands and feet-the ophthalmologic evaluation identified bitemporal hemianopia, suggesting optic chiasm compression. Laboratory results showed elevated ACTH, IGF-1, and prolactin levels, alongside confirmed hypercortisolism. The patient also had secondary diabetes mellitus and galactorrhea-initial treatment with octreotide provided limited benefit, with persistent hormone elevations and insufficient symptom control. The patient underwent endonasal endoscopic transsphenoidal resection of the pituitary macroadenoma, leading to marked symptomatic and hormonal improvements. This underscores the diagnostic challenge and treatment complexity of such cases. Early diagnosis is critical for optimizing outcomes in patients with hyperpituitarism and mitigating complications. This case highlights the importance of multidisciplinary management and the necessity of long-term follow-up to monitor for recurrence and ensure sustained remission.

Keywords: Acromegaly; Cushing; Hormone; Macroadenoma; Microadenoma; Pituitary.

Fig. 1

This sagittal T1-weighted postcontrast MRI of the brain, specifically focusing on the sella turcica region, reveals a large, homogeneously enhancing mass centered within the sella turcica, consistent with a pituitary macroadenoma. The mass exhibits clear, well-defined borders and appears to expand the sella, with extension into the suprasellar region (marked by circle).

Fig. 2

This image shows MRI scan of the brain in coronal T2-weighted images which reveals large suprasellar mass (marked by circles).

Fig. 3

Sagittal T1-weighted postcontrast MRI depicting a large, homogeneously enhancing pituitary macroadenoma within the sella turcica, expanding into the suprasellar region with well-defined borders (marked by arrows).

Fig. 4

Coronal T2-weighted MRI demonstrating a large, hyperintense pituitary macroadenoma within the sella turcica, extending into the suprasellar region (marked by arrows). The lesion displaces the optic chiasm and exhibits well-defined borders, suggesting potential mass effect.

Fig. 5

Axial T2-weighted MRI images of the brain showing a hyperintense lesion in the region of the basal ganglia and thalamus, indicated by white arrows. The lesion appears as a well-defined, bright signal, suggestive of a pathology affecting deep brain structure.