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  • Title: Failure of clinical remission after transsphenoidal removal of a microadenoma in a patient with Cushing's disease: multiple hyperplastic and adenomatous cell nets in surrounding pituitary tissue.
    Author: Lamberts SW, Stefanko SZ, de Lange SA, Fermin H, van der Vijver JC, Weber RF, de Jong FH.
    Journal: J Clin Endocrinol Metab; 1980 Apr; 50(4):793-5. PubMed ID: 7364932.
    Abstract:
    A patient with Cushing's disease is described who underwent transsphenoidal adenomectomy of a basophilic microadenoma with a diameter of 3 mm. In a piece of surrounding normal pituitary tissue removed at operation, multiple small nests of adenomatous basophilic cells were found both in the adeno- and neurohypophysis. No clinical improvement was observed. Cortisol secretory rate, plasma ACTH, the absent response of plasma cortisol to insulin-induced hypoglycemia, and the responses of plasma cortisol to lysine vasopressin and TRH remained unchanged. The observations in this patient point to the presence of multiple ACTH-secreting adenomatous cell nests and microadenomas throughout pituitary gland and bring back into view the concept of primary stimulation of hypothalamic corticotropin-releasing factor as the primary derangement in some patients with Cushing's disease.
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