Pituitary Tumours Manifested After Adrenalectomy for Cushing's Syndrome

Cushing's Syndrome Associated With a Suprasellar Tumour

“…Recently (Nelson et al 1958;Salassa et al 1959;Rees 8c Bayliss 1959;Montgomery et al 1959;Mason Sc Greenbaum 1962) there have been a number of cases reported to have developed pituitary tumours following total adrenal¬ ectomy for Cushing's syndrome. These latter cases have also had hyperpig¬ mentation and/or oculomotor or optic nerve involvement.…”

“…These latter cases have also had hyperpig¬ mentation and/or oculomotor or optic nerve involvement. This group will be referred to as »secondary pituitary tumour post total adrenalectomy for Cushing's syndrome.« In all the »secondary« cases (except one reported as a transitional basophilic carcinoma (Montgomery et al 1959), the pathology of the pituitary tumour has been that of an adenoma, usually chromophobe in character, although one instance of a basophilic adenoma has been reported (Rees 8c Bayliss 1959). In some of the »secondary« cases a pituitary tumour may have been present before adrenalectomy, although not reflected in an increase in the size of the sella.…”

“…In many of these (Nelson et al 1958;Salassa et al 1959;Rees 8c Bayliss 1959;Montgomery et al 1959;Mason 8c Greenbaum 1962), the existence of the pituitary tumour was recognized only after subtotal or total adrenalectomy had been performed. In a smaller group (Cohen 8c Dible 1936;Feiring et al 1953;Brown et al 1955;Doret 1956;Hauger 8c Laken 1960;Simkin et al 1962; My erson 8c Hingston 1962), the pituitary tumour was noted coincident with the onset of the manifestations of Cushing's syndrome.…”

Cushing's Syndrome and Skin Pigmentation

“…Such chromophobe adenomas are very rich in A.C.T.H. (Bayliss, 1959;Montgomery et al, 1959) and also differ from other chromophobe tumours in their propensity for local invasion causing cranial nerve palsies (Salassa et at., 1959). Pituitary tumours in Cushing's syndrome maintain or increase their endocrine activity as they grow larger, but the cell type changes from basophil to chromophobe.…”

Pitfalls in the management of Cushing’s disease

“…34,35 However, reports of morbidity and mortality with permenant glucocorticoid and mineralocorticoid deficiency and development of large and progressive pituitary tumors after adrenalectomy were published, and this has been abandoned as an initial treatment. [36][37][38] Adrenalectomy is a radical therapeutic option to control persistent hypercortisolism in some patients with CD. This treatment is uncommonly (10-40%) followed by the development of Nelson's syndrome (NS) when the autonomous pituitary receives inadequate glucocorticoid feedback from exogenous steroid replacement.…”