Ann Pediatr Endocrinol Metab.  2017 Sep;22(3):197-202. 10.6065/apem.2017.22.3.197.

A rare case of multiple pituitary adenomas in an adolescent Cushing disease presenting as a vertebral compression fracture

Affiliations
  • 1Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan, Korea. ymk@pusan.ac.kr
  • 2Department of Otorhinolaryngology, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 3Department of Neurosergery, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 4Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 5Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea.

Abstract

Cushing disease in children and adolescents, especially with multiple pituitary adenomas (MPAs), is very rare. We report 17-year-old boy with MPAs. He presented with a vertebral compression fracture, weight gain, short stature, headache, and hypertension. On magnetic resonance imaging (MRI), only a left pituitary microadenoma was found. After surgery, transient clinical improvement was observed but headache and hypertension were observed again after 3 months later. Follow-up MRI showed a newly developed right pituitary microadenoma 6 months after the surgery. The need for careful clinical and radiographic follow-up should be emphasized in the search for potential MPAs in patients with persistent Cushing disease.

Keyword

Adolescent; Cushing disease; Multiple pituitary adenomas; Transsphenoidal surgery

MeSH Terms

Adolescent*
Child
Follow-Up Studies
Fractures, Compression*
Headache
Humans
Hypertension
Magnetic Resonance Imaging
Male
Pituitary ACTH Hypersecretion*
Pituitary Neoplasms*
Weight Gain

Figure

  • Fig. 1. Growth curve (A) and clinical photos of a patient with Cushing disease showing typical Cushingoid features, including a moon shaped face, buffalo hump, multiple abdominal striae, central obesity, and hypertrichosis (B, C).

  • Fig. 2. Simple spinal X-ray and serial pituitary magnetic resonance images of a patient with Cushing disease. (A) Spinal X-ray showing diffuse osteopenia and a compression fracture of the T9, L2, and T3 vertebral bodies. (B) T2-weighted coronal view showing an 8-mm microadenoma in the left pituitary gland (white arrow). (C) T2-weighted coronal view after the first operation showing a 9-mm microadenoma in the right pituitary gland (white arrow). (D) T2-weighted coronal view after the second operation showing a homogenous pituitary gland.


Reference

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