ACTH secreting macroadenomas and pituitary apoplexy are unusual in Cushing
disease. In the few cases reported in the literature, they have been found
in long term hypercortisolism. We communicate a 43 yr old woman with a 4 ye
ar evolution Cushing syndrome, who developed sudden cephalea and oftalmople
jia. A Computed Tomography of the pituitary fossa disclosed a macroadenoma
with intracapsular hemorrhage and suprasellar expansion. In the functional
tests, serum cortisol was suppressed with dexamethasone in a dose of 1 and
8 mg and responded to the desmopressin stimulus. Nevertheless, cortisol lev
els were lower than those observed in Cushing syndrome of similar magnitude
. The tumor was resected by transphenoidal surgery and immunohistochemistry
to ACTH was positive. In this case, the laboratory results suggest a parti
al remission of the hypercortisolism after pituitary apoplexy.