Carcinoma of the Hypophysis Associated With Cushing's Syndrome and Addisonian Pigmentation

Abstract

A patient suffering from Cushing's syndrome associated with carcinoma of the hypophysis and Addisonian pigmentation is described. It is pointed out that in a patient with Cushing's syndrome, distinct pigmentation may suggest carcinoma of the hypophysis, particularly when combined with an enlarged sella turcica and lack of response to irradiation of the pituitary area. I N A patient suffering from Cushing's syndrome recently seen in this hospital a carcinoma of the hypophysis was found at autopsy. The patient also showed a characteristic Addisonian pigmentation, and for this reason the case is considered worthy of publication. CASE REPORTThe patient was a 51-year-old housewife who previously had been in good health. From January 1955 she complained of polydipsia, pigmentation of the skin, particularly of the face, the neck and the abdomen. There was growth of hair on the face, necessitating shaving once a week. She also complained of frequent headaches and nausea. Little by little she became apathetic and her muscular and intellectual powers declined. Her menstrual periods had stopped two years previously. In April 1956 the positive findings in a local hospital were a Cushingoid habitus, eosinopenia, decreased glucose tolerance and an enlarged sella on x-ray examination. These findings were confirmed in the neurological department of this hospital, and she was transferred to the medical department for further study and treatment.On admission on May 30, 1956, she felt reasonably well except for asthenia. Her face was round and plethoric with slight hirsutism. She was obese, the obesity being limited to the face, neck, shoulders and abdomen; the extremities were thin. She had many purplish striae over the abdomen, and also ecchymotic areas, particularly over the upper extremities. Her face, chest and abdomen were deeply pigmented, as were the palms of the hands, the knuckles of the fingers, and the elbows. Areolar pigmentation was increased. No oral pigmentation, and no freckles, vitiligo or leukoderma were observed. The blood pressure was 145 mm. Hg systolic and 95 mm. diastolic. Laboratory data: The hemoglobin level and red and white blood cell counts were within normal limits. There were 19 eosinophils per cu. mm. The oral glucose tolerance test after 50 Gm. of glucose showed the following blood sugar levels: control, 109 mg. per 100 ml.; thirty minutes, 219 mg.; one hour, 224 mg.; two hours, 153 mg.; and three