Clinicopathological variations in cushing's syndrome

Area of Science:

• Endocrinology
• Neurosurgery
• Pathology

Background:

• Cushing's disease is often caused by small corticotroph microadenomas (<5 mm).
• Accurate preoperative localization is crucial for successful transsphenoidal microsurgery.
• ACTH-dependent Cushing's syndrome diagnosis and management can be challenging.

Purpose of the Study:

• To present pathological findings and clinical outcomes of four Cushing's disease patients.
• To evaluate the utility of inferior petrosal sinus sampling (IPSS) in diagnosis and treatment.
• To highlight the role of a multidisciplinary approach in managing complex cases.

Main Methods:

• Four patients with ACTH-dependent Cushing's syndrome underwent IPSS, pituitary imaging (MRI), and transsphenoidal surgery.
• Pathological examination of resected tissue was performed.
• Clinical and biochemical outcomes were assessed post-surgery.

Main Results:

• IPSS accurately localized the lesion in all four cases.
• Histology confirmed corticotroph adenoma in two patients; one showed Crooke's hyalinization.
• MRI provided false positives in two cases and correctly identified the lesion site in only one.

Conclusions:

• IPSS is a valuable tool for precise localization in Cushing's disease management.
• Successful treatment relies on integrating clinical, biochemical, imaging, and pathological data.
• A multidisciplinary approach is essential for complex Cushing's disease cases.