EXTRASELLAR, INTRACAVERNOUS SINUS ADRENOCORTICOTROPIN RELEASING ADENOMA CAUSING CUSHINGS-DISEASE

This report describes a patient with pituitary-dependent Gushing's dis ease who had a preoperative ACTH gradient to the left at the level of the cavernous sinus. Intraoperatively, an adenoma was found entirely w ithin the left cavernous sinus, with no direct connection to the pitui tary gland. To our knowledge, such a tumor has not been reported previ ously. This case has implications for the diagnosis, treatment, and fo llow-up of patients with pituitary-dependent Gushing's disease. The pr esence of an entirely extrasellar ACTH-releasing adenoma in the cavern ous sinus could explain why pituitary-dependent Gushing's disease may persist postoperatively, even after total hypophysectomy. The diagnosi s of an intracavernous tumor can be established by cavernous sinus ven ography. An extrasellar intracavernous adenoma can be diagnosed intrao peratively after careful negative exploration of the sellar contents f ollowed by incision of the cavernous sinus on the side of the ACTH gra dient established by venous sampling.