Subclinical Cushing Syndrome Associated with an Empty Sella Turcica

Abstract

The coexistence of adrenocorticotropic hormone (ACTH)-independent Cushing syndrome (CS) and an empty sella (ES) is rare (1, 2). A 53-year-old woman presented with an ES (Picture A, B) and a 40×25-mm left adrenal tumor (Picture C). She had no Cushingoid features, hypertension or diabetes. The levels of morning plasma ACTH, cortisol, dehydroepiandrosterone sulfate and urinary free cortisol were 1.8 (reference range, 7.2-63.3) pg/mL, 5.7 (4.0-19.3) μg/dL, <50 (180-2,100) ng/mL and 9.6 (11.2-80.3) μg/day, respectively. Overnight 1-and 8-mg dexamethasone suppression tests indicated unsuppressed morning cortisol levels (3.2 and 2.8 μg/dL, respectively).131 I-adosterol scintigraphy revealed a strong left adrenal uptake (Picture D). These findings suggested subclinical CS (SCS).

Zmiany torbielowate okolicy siodłowo-nadsiodłowej — diagnostyka i leczenie

“…The coexistence of empty sella syndrome and pituitary adenoma has been described in literature [56,57]. The coincidence of these two pathologies requires further studies.…”