The Triple Hormone Enigma: Pituitary Macroadenoma With Bilateral Cortisol-Androgen Secreting Adenomas

The coexistence of a pituitary macroadenoma co-secreting growth hormone (GH) and adrenocorticotropic hormone (ACTH) with bilateral adrenal adenomas autonomously producing cortisol and androgens represents an extremely rare and diagnostically complex clinical entity. We describe a 54-year-old woman who presented with acral enlargement, hirsutism, hyperpigmentation, and poorly controlled diabetes and hypertension. Hormonal evaluation revealed concurrent elevations in GH, ACTH, cortisol, dehydroepiandrosterone sulfate, and testosterone. Contrast-enhanced magnetic resonance imaging of the brain showed a pituitary macroadenoma, and abdominal imaging revealed bilateral adrenal masses. Despite undergoing transsphenoidal surgery and subsequent radiosurgery, the patient exhibited persistent hypercortisolism and androgen excess. Bilateral adrenalectomy was performed, and histopathology confirmed benign adrenocortical adenomas. The patient subsequently achieved biochemical remission and marked clinical improvement. This case highlights the need for comprehensive hormonal and imaging workup in patients with mixed clinical features and emphasizes the importance of a multidisciplinary approach to diagnosis and management in the context of multiple endocrine pathologies.