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Case Reports in Endocrinology
Volume 2017, Article ID 2419590, 5 pages
https://doi.org/10.1155/2017/2419590
Case Report

A Rapid Biochemical and Radiological Response to the Concomitant Therapy with Temozolomide and Radiotherapy in an Aggressive ACTH Pituitary Adenoma

1Department of Oncology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
2Zagreb University School of Medicine, Department of Endocrinology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
3Department of Endocrinology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
4Osijek University School of Medicine, Department of Oncology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
5Department of Radiology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia

Correspondence should be addressed to Ana Misir Krpan; moc.oohay@naprkrisimana

Received 28 December 2016; Revised 5 February 2017; Accepted 13 February 2017; Published 5 March 2017

Academic Editor: Takeshi Usui

Copyright © 2017 Ana Misir Krpan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Importance. In the last eight years temozolomide (TMZ) has been used as the last-line treatment modality for aggressive pituitary tumors to be applied after the failure of surgery, medical therapy, and radiotherapy. The objective was to achieve a rapid control of tumor growth and hormone normalization with concurrent chemoradiotherapy in a patient with very aggressive ACTH pituitary adenoma. Clinical Presentation. We describe a patient with an aggressive ACTH-producing adenoma treated with concurrent temozolomide and radiotherapy. The patient suffered from an aggressive ACTH adenoma resistant to surgical and medical treatment. After two months of concurrent temozolomide and radiotherapy, cortisol normalization and significant tumor shrinkage were observed. After 22 months of follow-up, there is still no evidence of tumor recurrence. Conclusion. Concurrent treatment with temozolomide and irradiation appears to be highly effective in the achievement of the tumor volume control as well as in the control of ACTH secretion in aggressive ACTH adenoma.