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Updated: May 27, 2026

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Adrenocorticotropin-secreting pituitary macroadenomas: expanding the clinical spectrum
Caitlin Iyer1, Nicola Havenga1, David Roytowski2
1Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Tygerberg Hospital and Stellenbosch University, Cape Town 7505, South Africa.
Abstract:
Cushing disease (CD) secondary to adrenocorticotropin (ACTH)-secreting pituitary macroadenomas is uncommon, accounting for 10% to 15% of cases. We describe 3 patients from South Africa who presented with overt clinical features of hypercortisolism and considerable systemic complications, including hypertension, diabetes mellitus, and osteoporosis. Biochemical testing confirmed ACTH-dependent hypercortisolism with hypopituitarism and mild hyperprolactinemia consistent with stalk effect. Magnetic resonance imaging demonstrated pituitary macroadenomas, measuring 10 mm or greater, with parasellar extension. Mass effect was observed in 1 patient resulting in cranial nerve III palsy, while the others had visual field deficits secondary to optic chiasm compression. All patients underwent endoscopic transsphenoidal surgery, with 1 achieving remission and 2 developing recurrence. These cases highlight that ACTH-secreting macroadenomas can present with severe systemic disease and significant mass effect, and emphasize the importance of lifelong follow-up.
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