SILENT NECROSIS OF A PITUITARY CORTICOTROPH ADENOMA REVEALED BY TIMELY MAGNETIC-RESONANCE-IMAGING - A CAUSE OF SPONTANEOUS REMISSION OF CUSHINGS-DISEASE

Spontaneous necrosis of a corticotroph adenoma is rare and is a very u nlikely way of curing Cushing's disease. We report hereafter a case wh ere magnetic resonance imaging of the pituitary provided clear evidenc e of the event. Successive and timely pituitary magnetic resonance ima ging in this patient showed first a typical microadenoma as a well-lim ited mass with a low signal intensity before the necrosis, then a brig ht signal before gadolinium injection in the T1-weighted image at the time of the event and, finally, the aspect of an empty sella turcica w ith a small arachnoidocele 1 year later. The necrosis of a corticotrop h adenoma is more frequent in macro- than in microadenomas, and is usu ally heralded by headache and visual disturbances. In this case, pitui tary necrosis was entirely asymptomatic, and cured the patient as well as the surgeon's knife would have. Nevertheless, this exceptional occ urrence does not rule out the possibility of a recurrence.