Related Experiment Video
Updated: Apr 27, 2026
07:43
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
18.5K
Addison's Disease and Pituitary Enlargement
Stephen J Winters1, Todd Vitaz, Michael R Nowacki
1Division of Endocrinology, Metabolism and Diabetes (SJW), University of Louisville School of Medicine, Louisville, Kentucky; Department of Radiation Oncology (CS), University of Louisville School of Medicine, Louisville, Kentucky; Brain Tumor Center (TV), Norton Neuroscience Institute; and Departments of Pathology (MRN), Radiology (DCC), Norton Health Care, Louisville, Kentucky.
The American Journal of the Medical Sciences
|July 9, 2014
Summary
Primary adrenal failure can lead to corticotroph hyperplasia and invasive pituitary adenomas. Monitor ACTH levels and pituitary imaging in patients with increased skin pigmentation during hormone replacement therapy.
Area of Science:
- Endocrinology
- Neuro-oncology
- Pituitary Disorders
Background:
- Patients with primary adrenal insufficiency require long-term glucocorticoid and mineralocorticoid replacement.
- Uncontrolled stimulation of the pituitary gland can occur due to prolonged lack of adrenal feedback.
- This can lead to corticotroph hyperplasia and potentially pituitary adenoma formation.
Observation:
- A 60-year-old male with Addison's disease, hypothyroidism, and type 2 diabetes developed hyperpigmentation and bitemporal hemianopia.
- Elevated plasma ACTH levels (14,464 pg/mL) were detected.
- Magnetic resonance imaging revealed an invasive pituitary macroadenoma with suprasellar extension.
Findings:
- Surgical resection of the pituitary macroadenoma, identified as an ACTH-producing eosinophilic adenoma, was performed.
- The patient received stereotactic radiotherapy for residual tumor.
- Analysis of this case and prior literature suggests primary adrenal failure predisposes to corticotroph hyperplasia and invasive adenomas.
Implications:
- Increased skin pigmentation in patients with primary adrenal failure on standard hormone therapy warrants ACTH level measurement and pituitary MRI.
- Early detection and management of pituitary macroadenomas are crucial in this patient population.
- Understanding the link between adrenal insufficiency and pituitary tumors can improve patient monitoring and outcomes.
Related Concept Videos
01:27Adrenal Gland Disorders
3.7K
Adrenal gland disorders manifest when the production of adrenal hormones deviates from the norm, resulting in either excessive or insufficient concentrations.
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
3.7K
01:19Cushing Syndrome II: Pathophysiology
21
Cortisol production is normally governed by the hypothalamic–pituitary–adrenal (HPA) axis, which maintains hormonal balance through tightly regulated feedback mechanisms. Disruption of this regulatory system is central to the development of Cushing syndrome, whether the excess cortisol originates from external medications or internal pathology. Persistent cortisol elevation alters metabolism, immune function, and endocrine signaling, producing the characteristic clinical features...
21
01:26Cushing Syndrome I: Introduction
27
Cushing syndrome refers to the collection of clinical manifestations that arise when tissues are exposed to excessive amounts of cortisol or cortisol-like medications over an extended period. Cortisol, a glucocorticoid produced by the adrenal cortex, regulates metabolism, immune responses, and the body’s adaptation to stress. When its concentration remains chronically elevated, these physiological pathways become dysregulated, resulting in the characteristic features of the...
27
01:24Graves Disease II: Pathophysiology
15
Graves’ disease is an autoimmune disorder characterized by the production of thyroid-stimulating immunoglobulins (TSI) that activate TSH receptors, leading to excessive synthesis and release of thyroid hormones (T3 and T4) and resulting in hyperthyroidism.Among all causes of hyperthyroidism, Graves’ disease is the most common and can happen at any age, though it is more frequent in women. It produces a hypermetabolic state with features such as weight loss, tachycardia, tremor,...
15
01:27Hyperthyroidism II: Pathophysiology
25
Hyperthyroidism is a hypermetabolic state caused by elevated levels of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). It results from dysregulation at the thyroid, pituitary, or immune system level and affects multiple organ systems.PathophysiologyThe most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder in which antibodies, specifically thyroid-stimulating antibodies (TSAb), a subtype of TSH receptor antibodies (TRAb), bind to and activate TSH...
25
01:27Goiter
27
Goiter refers to an abnormal enlargement of the thyroid gland that may appear as a diffuse goiter (uniform enlargement) or nodular (single or multiple nodules). Functionally, it is classified as nontoxic (normal/low hormone levels) or toxic (excess hormone production).PathophysiologyDiffuse thyroid enlargement typically results from prolonged stimulation by thyroid-stimulating hormone (TSH) or TSH-like agents, commonly seen in hypothyroidism or iodine deficiency. In contrast, in hyperthyroid...
27