Abstract #1 Cushing’s Disease Manifesting as Multiple Pituitary Adenomas With Corticotroph Hyperplasia

1 Cushing’s Disease Manifesting as Multiple Pituitary Adenomas With Corticotroph Hyperplasia Anupam Srivastava, MD, and Romesh K. Khardori, MD, FACE A 51-year-old man presented with chief complaints of proximal muscle weakness and drooping of eyelids. An initial diagnosis of seronegative myasthenia gravis was made, and he was empirically treated with corticosteroids, which made his symptoms worse. Further work-up, which included low-dose and high-dose dexamethasone suppression testing, revealed results suggestive of Cushing’s disease. Magnetic resonance imaging (MRI) of the pituitary gland disclosed findings consistent with a microadenoma. Cushing’s disease was diagnosed, and the patient underwent transsphenoidal resection of the adenoma. He felt symptomatically better postoperatively but had similar complaints after 1 year. Repeated MRI showed a 7-mm pituitary adenoma on the left side. The patient underwent a second transsphenoidal adenomectomy. MRI after 6 months showed several 3-mm adenomas on the left and a 6-mm adenoma on the right side of the pituitary gland. The patient underwent a third operation at a different institution. Most patients with Cushing’s disease have a solitary corticotroph microadenoma but rarely may have diffuse corticotroph hyperplasia. Occurrence of multiple adenomas, as in our patient, is very uncommon, and in such cases, the therapeutic approach should be hypophysectomy rather than adenomectomy.