Failure of Clinical Remission after Transsphenoidal Removal of a Microadenoma in a Patient with Cushing’s Disease: Multiple Hyperplastic and Adenomatous Cell Nests in Surrounding Pituitary Tissuetitle

摘要: A patient with Cushing's disease is described who underwent transsphenoidal adenomectomy of a basophilic microadenoma diameter 3 mm. In piece surrounding normal pituitary tissue removed at operation, multiple small nests adenomatous cells were found both in the adeno- and neurohypophysis. No clinical improvement was observed. Cortisol secretory rate, plasma ACTH, absent response cortisol to insulin-induced hypoglycemia, responses lysine vasopressin TRH remained unchanged. The observations this point presence ACTH-secreting cell microadenomas throughout gland bring back into view concept primary stimulation hypothalamic corticotropin-releasing factor as derangement some patients disease.