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A patient with Cushing disease lateralizing a pituitary adenoma by inferior petrosal sinus sampling using desmopressin: a case report.

Lim JH, Kim SJ, Jung MK, Kim KE, Kwon AR, Chae HW, Kim DH, Kim HS - Ann Pediatr Endocrinol Metab (2016)

Bottom Line: During the previous 2 years, she had experienced weight gain, secondary amenorrhea, growth retardation, and back pain.Pituitary magnetic resonance imaging was suspicious for microadenoma.To eliminate ectopic ACTH syndrome, and lateralize the pituitary tumor, inferior petrosal sinus sampling (IPSS) was performed by desmopressin use to stimulate ACTH.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
A 14-year-old girl was referred for evaluation of the etiology of Cushing syndrome. During the previous 2 years, she had experienced weight gain, secondary amenorrhea, growth retardation, and back pain. Random serum cortisol level, 24-hour urinary free cortisol excretion, and overnight and low-dose dexamethasone suppression tests suggested Cushing syndrome. Midnight adrenocorticotropic hormone (ACTH) level and high-dose dexamethasone suppression test confirmed Cushing disease. Pituitary magnetic resonance imaging was suspicious for microadenoma. To eliminate ectopic ACTH syndrome, and lateralize the pituitary tumor, inferior petrosal sinus sampling (IPSS) was performed by desmopressin use to stimulate ACTH. Finally, the patient was diagnosed with Cushing disease due to ACTH-secreting pituitary microadenoma, lateralized to the left side; subsequently underwent transsphenoidal surgery. Here we report a case of a 14-year-old girl diagnosed with Cushing disease with a pituitary tumor lateralized by IPSS using desmopressin, which is very rare in pediatric Cushing disease.

No MeSH data available.


Related in: MedlinePlus

Preoperative imaging study including magnetic resonance imaging (A, B) and positron emission tomography-computed tomography pre- (C) and postdexamethasone injection (D), suggesting microadenoma.
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Figure 2: Preoperative imaging study including magnetic resonance imaging (A, B) and positron emission tomography-computed tomography pre- (C) and postdexamethasone injection (D), suggesting microadenoma.

Mentions: As her previous test results strongly suggested Cushing disease rather than an ectopic ACTH-producing tumor, a thin-slice pituitary MRI was performed. The MRI showed a heterogeneous enhancing lesion (approximately 6 mm) in the midline area of posterior aspect of the pituitary fossa, and pituitary microadenoma was suspected (Fig. 2A, B). A positron emission tomography study also found diffuse 18-fluorodeoxyglucose uptake in an area consistent with the MRI which was not suppressed after dexamethasone, thus supporting the MRI findings of an adenoma (Fig. 2C, D). An In-111 Octreoscan (Mallinckrodt Nuclear Medicine, Maryland Heights, MO, USA) showed no evidence of ectopic ACTH-secreting tumor.


A patient with Cushing disease lateralizing a pituitary adenoma by inferior petrosal sinus sampling using desmopressin: a case report.

Lim JH, Kim SJ, Jung MK, Kim KE, Kwon AR, Chae HW, Kim DH, Kim HS - Ann Pediatr Endocrinol Metab (2016)

Preoperative imaging study including magnetic resonance imaging (A, B) and positron emission tomography-computed tomography pre- (C) and postdexamethasone injection (D), suggesting microadenoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835561&req=5

Figure 2: Preoperative imaging study including magnetic resonance imaging (A, B) and positron emission tomography-computed tomography pre- (C) and postdexamethasone injection (D), suggesting microadenoma.
Mentions: As her previous test results strongly suggested Cushing disease rather than an ectopic ACTH-producing tumor, a thin-slice pituitary MRI was performed. The MRI showed a heterogeneous enhancing lesion (approximately 6 mm) in the midline area of posterior aspect of the pituitary fossa, and pituitary microadenoma was suspected (Fig. 2A, B). A positron emission tomography study also found diffuse 18-fluorodeoxyglucose uptake in an area consistent with the MRI which was not suppressed after dexamethasone, thus supporting the MRI findings of an adenoma (Fig. 2C, D). An In-111 Octreoscan (Mallinckrodt Nuclear Medicine, Maryland Heights, MO, USA) showed no evidence of ectopic ACTH-secreting tumor.

Bottom Line: During the previous 2 years, she had experienced weight gain, secondary amenorrhea, growth retardation, and back pain.Pituitary magnetic resonance imaging was suspicious for microadenoma.To eliminate ectopic ACTH syndrome, and lateralize the pituitary tumor, inferior petrosal sinus sampling (IPSS) was performed by desmopressin use to stimulate ACTH.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
A 14-year-old girl was referred for evaluation of the etiology of Cushing syndrome. During the previous 2 years, she had experienced weight gain, secondary amenorrhea, growth retardation, and back pain. Random serum cortisol level, 24-hour urinary free cortisol excretion, and overnight and low-dose dexamethasone suppression tests suggested Cushing syndrome. Midnight adrenocorticotropic hormone (ACTH) level and high-dose dexamethasone suppression test confirmed Cushing disease. Pituitary magnetic resonance imaging was suspicious for microadenoma. To eliminate ectopic ACTH syndrome, and lateralize the pituitary tumor, inferior petrosal sinus sampling (IPSS) was performed by desmopressin use to stimulate ACTH. Finally, the patient was diagnosed with Cushing disease due to ACTH-secreting pituitary microadenoma, lateralized to the left side; subsequently underwent transsphenoidal surgery. Here we report a case of a 14-year-old girl diagnosed with Cushing disease with a pituitary tumor lateralized by IPSS using desmopressin, which is very rare in pediatric Cushing disease.

No MeSH data available.


Related in: MedlinePlus