Progression of an Invasive ACTH Pituitary Macroadenoma with Cushing’s Disease to Pituitary Carcinoma

Table 1

Clinical course.

Data	Condition	24 h urinary cortisol	Late salivary cortisol	Serum morning cortisol	ACTH
Dec 2009	Before 3rd surgery	>1,100	6.45	51.8	793
Dec 2009	3rd  TS surgery
Jan 2010	Postoperative (no GC replacement)			4.4	46
Feb 2010	No GC replacement	54.6	0.11	5.7	62
Jun 2010	GC dependency replacement	20	<0.1	2.3	60
Dec 2010	GC dependency replacement	25.2	0.04	3.2	45
Mar 2011	GC dependency replacement	25	0.08	2.8	59
Apr 2012	Clinical recurrence of CS	170	0.12	16.5	270
May 2012	No drug	435	0.21	25.3	336
Jul 2012	On 1,200 mg/d of ketoconazole	821	0.52	23.5	670
Jul 2012	4th surgery
Sep 2012	Postoperative (no drug)	4,998	2.44	47.7	582
Nov 2012	Radiotherapy
Feb 2013	Postradiotherapy	2,348	13.5	70.8	4,087

24h urinary cortisol (NR: 30–310 μg/24 h).
Late salivary cortisol (NR < 0.13 μg/dL).
Serum morning cortisol (NR: 5–25 μg/dL).
ACTH (NR: <46 pg/mL).
GC: glucocorticoid, CS: Cushing’s syndrome.