A Case of Spontaneously Resolving Cushing Disease.

Area of Science:

• Endocrinology
• Neuroendocrinology
• Pituitary Disorders

Background:

• Cushing disease (CD) is a rare endocrine disorder caused by a pituitary adenoma secreting excess ACTH.
• Diagnosis often involves complex testing for hypercortisolism and localization of the pituitary adenoma.
• Treatment typically includes surgery, radiation, or medication, with varying success rates.

Observation:

• A 20-year-old female presented with hyperprolactinemia and an 11 mm pituitary lesion, initially treated with cabergoline.
• Over time, she developed symptoms and biochemical evidence of Cushing disease (CD), indicating hypercortisolism.
• Despite initial growth, a subsequent MRI revealed complete resolution of the pituitary adenoma.

Findings:

• The patient experienced spontaneous remission of Cushing disease (CD), with normalization of cortisol levels and resolution of symptoms.
• The pituitary adenoma completely disappeared on MRI, a highly unusual occurrence.
• The spontaneous remission may have been influenced by cabergoline treatment or an undetected pituitary apoplexy.

Implications:

• This case highlights the unpredictable natural history of Cushing disease (CD) and the possibility of spontaneous remission.
• It suggests that pituitary apoplexy or even medication may play a role in tumor regression.
• Further research is needed to understand the mechanisms behind spontaneous CD remission and its potential therapeutic implications.