Case Report

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

Table 1

Clinical course.

DataCondition24 h urinary cortisolLate salivary cortisolSerum morning cortisolACTH

Dec 2009Before 3rd surgery>1,1006.4551.8793
Dec 20093rd  TS surgery
Jan 2010Postoperative (no GC replacement)4.446
Feb 2010No GC replacement54.60.115.762
Jun 2010 GC dependency replacement20<0.12.360
Dec 2010GC dependency replacement25.20.043.245
Mar 2011GC dependency replacement250.082.859
Apr 2012Clinical recurrence of CS1700.1216.5270
May 2012No drug4350.2125.3336
Jul 2012On 1,200 mg/d of ketoconazole8210.5223.5670
Jul 20124th surgery
Sep 2012Postoperative (no drug)4,9982.4447.7582
Nov 2012Radiotherapy
Feb 2013Postradiotherapy 2,34813.570.84,087

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.