G. Dickstein et al., LATE COMPLICATIONS IN REMISSION FROM CUSHING DISEASE - RECURRENCE OF TUMOR WITH REINFARCTION OR TRANSFORMATION INTO A SILENT ADENOMA, Archives of internal medicine, 157(20), 1997, pp. 2377-2380
Two of 4 patients who underwent spontaneous remission from Gushing dis
ease (CD) demonstrated regrowth of the pituitary adenoma 2 and 5 years
later. In the first patient, the recurrent tumor also secreted cortic
otropin, with subsequent relapse of fulminant cushingoid features. How
ever, after 14 more months, it again became infarcted, and the patient
underwent complete clinical remission, which has persisted for about
3 years. In the second patient, the regrowth of the tumor occurred sil
ently, as no clinical cushingoid features or rise in cortisol levels w
ere noticed. Because of its size, the tumor was resected and found to
have immunoreactivity for corticotropin (silent corticotroph adenoma).
About 4 years after the first operation, a second surgical procedure
was performed because of massive regrowth of the tumor. Again, there w
as no concomitant elevation of cortisol levels or endocrinologic sympt
oms. This time, the tumor did not even stain for corticotropin. While
spontaneous remission in CD is rare, recurrence is even rarer. Reremis
sion of CD and the change from a corticotropin-secreting adenoma to a
silent one are described herein for the first time (to our knowledge).
These cases demonstrate that patients with CD have to receive careful
follow-up, even if they undergo remission, and that the long-term out
come of such remission is unpredictable.