ENFERMEDAD DE CUSHING: DESCRIPCIÓN DE UN CASO TRATADO CON CIRUGÍA TRANSESFENOIDAL

Carlos Ríos; Walter Kravcio; Avelino Gutiérrez

Submitted October 29, 2024

Published 2026-04-06

Artículos de Investigación

Vol. 20 No. 2 (2007): Revista Médico Científica

CUSHING'S DISEASE: DESCRIPTION OF A CASE TREATED TRANSESFENOIDAL WITH SURGERY

Carlos Ríos ⁺⁻
Walter Kravcio⁺⁻
Avelino Gutiérrez⁺⁻

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Published: 2026-04-06

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Abstract

ABSTRACT: A case of Cushing's disease that was successfully treated with transsphenoidal surgery in the Complejo Hospitalario Metropolitano Dr. Arnulfo A. Madrid is presented. The patient is a 33-year-old woman who was admitted at the Complejo Hospitalario due to an injury on the right lower limb, which did not improve in spite of conventional medical treatment. All of this was associated with symptoms of Cushing's disease.

Dexamethasone suppression testing was conducted and produced abnormal results. Neuroimaging investigations revealed "cloudiness in the sella turcica" in brain tomography and a pituitary microadenoma in magnetic resonance imaging with gadolinium injection.

The surgery was performed, without any complications, two months later. Endocrinologic follow-up did not require exogenous hormone therapy. The patient currently weighs 190 pounds compared to 260 pounds prior to surgery. Hypertension, acne, "buffalo hump," and other clinical symptoms have since disappeared. This is the first report of Cushing's disease being successfully treated with transsphenoidal surgery, with a two-year follow-up, documented in Panama.

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References

REFERENCIAS:
Derome PJ, Peillon F, Bard RH, Jedynak CP, Racadot J, Guiot G. Prolactin secreting adenomas: surgical treatment and results. 120 female cases, 30 male cases (traducción del autor) [Artículo en francés]. Nouv Presse Med. 1979 Feb 17; 8(8): 577-83.
Hardy J. The history of Cushing's disease [Artículo en francés]. Neurochirurgie. 2002 May; 48(2-3 Pt 2): 144-8.
Lindholm J. Cushing's syndrome: historical aspects. Pituitary. 2000 Oct; 3(2): 97-104.
Giraldi FP, Moro M, Cavagnini F; Study Group on the Hypothalamo-Pituitary-Adrenal Axis of the Italian Society of Endocrinology. Gender-related differences in the presentation and course of Cushing's disease. J Clin Endocrinol Metab. 2003 Apr; 88(4): 1554-8.
Neurosurgery second edition, volumen I. Editors: Robert H. Wilkins, M.D., Settis Renganathan, M.D. McGraw-Hill. 1996. Part VI, Neuro-Oncology, Section I, Sellar and Parasellar Tumors, pp. 1221-148.
Lamberts SW. Glucocorticoid receptors and Cushing's disease. Mol Cell Endocrinol. 2002 Nov; 197(1-2): 69-72.
Stratakis CA, Mastorakos G, Mitsiades NS, Mitsiades CS, Chrousos GP. Skin manifestations of Cushing's disease in children and adolescents before and after the resolution of hypercortisolemia. Pediatr Dermatol. 1998 Jul-Aug; 15(4): 253-8.
Farreras Valentí P, Rozman Medicina Interna. 5a edición, Volumen II. Editores: Dr. E. Vilardell-Latorre, Dr. Felipe Casanueva Feijo. Ediciones Harcourt S.A., 2004. Endocrinología, Sección 16, Enfermedades de las glándulas suprarrenales, pp. 2129-2135.
Harrison, Principios de Medicina Interna. 15a edición, Volumen II. Editores: Eugene Braunwald, M.D., Dan L. Longo, M.D. McGraw-Hill, 2002. 13a parte, Endocrinología y Metabolismo, Sección I, Cap. 328, Trastornos de la adenohipófisis y del hipotálamo, pp. 2395-2397.
Reimondo G, Paccotti P, Minetto M, Termine A, Stura G, Bergui M et al. The corticotrophin-releasing hormone test is the most reliable noninvasive method to differentiate pituitary from ectopic ACTH secretion in Cushing's syndrome. Clin Endocrinol (Oxf). 2003 Jun; 58(6): 718-24.
Kai Y, Hamada J, Nishi T, Morioka M, Mizuno T, Ushio Y. Usefulness of multiple-site venous sampling in the treatment of adrenocorticotropic hormone-producing pituitary adenomas. Surg Neurol. 2003 Apr; 59(4): 292-8; discussion 298-9.
Lefournier V, Martinie M, Vasdev A, Bessou P, Passagia JG, Labat-Moleur F et al. Accuracy of bilateral inferior petrosal or cavernous sinuses sampling in predicting the lateralization of Cushing's disease pituitary microadenoma: influence of catheter position and anatomy of venous drainage. J Clin Endocrinol Metab. 2003 Jan; 88(1): 196-203.
Losa M, Mortini P, Giovanelli M. The role of somatostatin analogues in the treatment of hypophyseal adenoma [Artículo en italiano]. Minerva Endocrinol. 2003 Mar; 28(1): 39-51.
Flitsch J, Knappe UJ, Lüdecke DK. The use of postoperative ACTH levels as a marker for successful transsphenoidal microsurgery in Cushing's disease. Zentralbl Neurochir. 2003; 64(1): 6-11.
Mahmoud-Ahmed AS, Suh JH. Radiation therapy for Cushing's disease: a review. Pituitary. 2002; 5(3): 175-80.
Kobayashi T, Kida I, Mori Y. Gamma knife radiosurgery in the treatment of Cushing disease: long-term results. J Neurosurg. 2002 Dec; 97(5 Suppl): 422-8.
Inder WJ, Espiner EA, MacFarlane MR. Outcome from surgical management of secretory pituitary adenomas in Christchurch, New Zealand. Intern Med J. 2003 Apr; 33(4): 168-73.
Dickerman RD, Oldfield EH. Basis of persistent and recurrent Cushing disease: an analysis of findings at repeated pituitary surgery. J Neurosurg. 2002 Dec; 97(6): 1343-9.
Kadashev BA, Trunin IK, Kasumova SL, Nersesian GD, Arapova SD. The results of neurosurgical treatment in Itsenko-Cushing's disease [Artículo en ruso]. Zh Vopr Neirokhir Im N N Burdenko. 1997 Oct-Dec; (4): 7-12.
Cannavò S, Almoto B, Dall'Asta C, Corsello S, Lovicu RM, De Menis E et al. Long-term results of treatment in patients with ACTH-secreting pituitary macroadenomas. Eur J Endocrinol. 2003 Sep; 149(3): 195-200.
Blevins LS Jr, Christy JH, Khajavi M, Tindall GT. Outcomes of therapy for Cushing's disease due to adrenocorticotropin-secreting pituitary macroadenomas. J Clin Endocrinol Metab. 1998 Jan; 83(1): 63-7.
Reitmeyer M, Vance ML, Laws ER Jr. The neurosurgical management of Cushing's disease. Mol Cell Endocrinol. 2002 Nov 29; 197(1-2): 73-9.
Welbourn RB. The evolution of transsphenoidal pituitary microsurgery. Surgery. 1986 Dec; 100(6): 1185-90.
Martinez Ruiz M, Gomez Bueno O, Molina Rodriguez MA, Gonzalez Casado I, Gracia Bouthelier R. [Diagnosis, treatment, and long-term outcome in Cushing's disease] [Artículo en español]. An Pediatr (Barc). 2003 Aug; 59(2): 183-6.
Day JD. Surgical approaches to suprasellar and parasellar tumors. Neurosurg Clin N Am. 2003 Jan; 14(1): 109-22.
Nakagawa T, Takashima T, Tomiyama K, Asada M. Approaches to the sella turcica in endoscopic pituitary surgery [Artículo en japonés]. Nippon Jibiinkoka Gakkai Kaiho. 2001 Jan; 104(1): 1-8.
Das K, Spencer W, Nwagwu CI, Schaeffer S, Wenk E, Weiss MH, Couldwell WT. Approaches to the sellar and parasellar region: anatomic comparison of endonasal-transsphenoidal, sublabial-transsphenoidal, and transethmoidal approaches. Neurol Res. 2001 Jan; 23(1): 5-14.
Calvo A, Purriel JA, Bastarrica E, Haberbeck MA. Tumors of the sellar region and the cavernous sinus. Evaluation of diagnostic procedures and therapeutic orientation. Acta Neurol Latinoam. 1980; 26(2): 11-122.

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[1] REFERENCIAS:

[2] Derome PJ, Peillon F, Bard RH, Jedynak CP, Racadot J, Guiot G. Prolactin secreting adenomas: surgical treatment and results. 120 female cases, 30 male cases (traducción del autor) [Artículo en francés]. Nouv Presse Med. 1979 Feb 17; 8(8): 577-83.

[3] Hardy J. The history of Cushing's disease [Artículo en francés]. Neurochirurgie. 2002 May; 48(2-3 Pt 2): 144-8.

[4] Lindholm J. Cushing's syndrome: historical aspects. Pituitary. 2000 Oct; 3(2): 97-104.

[5] Giraldi FP, Moro M, Cavagnini F; Study Group on the Hypothalamo-Pituitary-Adrenal Axis of the Italian Society of Endocrinology. Gender-related differences in the presentation and course of Cushing's disease. J Clin Endocrinol Metab. 2003 Apr; 88(4): 1554-8.

[6] Neurosurgery second edition, volumen I. Editors: Robert H. Wilkins, M.D., Settis Renganathan, M.D. McGraw-Hill. 1996. Part VI, Neuro-Oncology, Section I, Sellar and Parasellar Tumors, pp. 1221-148.

[7] Lamberts SW. Glucocorticoid receptors and Cushing's disease. Mol Cell Endocrinol. 2002 Nov; 197(1-2): 69-72.

[8] Stratakis CA, Mastorakos G, Mitsiades NS, Mitsiades CS, Chrousos GP. Skin manifestations of Cushing's disease in children and adolescents before and after the resolution of hypercortisolemia. Pediatr Dermatol. 1998 Jul-Aug; 15(4): 253-8.

[9] Farreras Valentí P, Rozman Medicina Interna. 5a edición, Volumen II. Editores: Dr. E. Vilardell-Latorre, Dr. Felipe Casanueva Feijo. Ediciones Harcourt S.A., 2004. Endocrinología, Sección 16, Enfermedades de las glándulas suprarrenales, pp. 2129-2135.

[10] Harrison, Principios de Medicina Interna. 15a edición, Volumen II. Editores: Eugene Braunwald, M.D., Dan L. Longo, M.D. McGraw-Hill, 2002. 13a parte, Endocrinología y Metabolismo, Sección I, Cap. 328, Trastornos de la adenohipófisis y del hipotálamo, pp. 2395-2397.

[11] Reimondo G, Paccotti P, Minetto M, Termine A, Stura G, Bergui M et al. The corticotrophin-releasing hormone test is the most reliable noninvasive method to differentiate pituitary from ectopic ACTH secretion in Cushing's syndrome. Clin Endocrinol (Oxf). 2003 Jun; 58(6): 718-24.

[12] Kai Y, Hamada J, Nishi T, Morioka M, Mizuno T, Ushio Y. Usefulness of multiple-site venous sampling in the treatment of adrenocorticotropic hormone-producing pituitary adenomas. Surg Neurol. 2003 Apr; 59(4): 292-8; discussion 298-9.

[13] Lefournier V, Martinie M, Vasdev A, Bessou P, Passagia JG, Labat-Moleur F et al. Accuracy of bilateral inferior petrosal or cavernous sinuses sampling in predicting the lateralization of Cushing's disease pituitary microadenoma: influence of catheter position and anatomy of venous drainage. J Clin Endocrinol Metab. 2003 Jan; 88(1): 196-203.

[14] Losa M, Mortini P, Giovanelli M. The role of somatostatin analogues in the treatment of hypophyseal adenoma [Artículo en italiano]. Minerva Endocrinol. 2003 Mar; 28(1): 39-51.

[15] Flitsch J, Knappe UJ, Lüdecke DK. The use of postoperative ACTH levels as a marker for successful transsphenoidal microsurgery in Cushing's disease. Zentralbl Neurochir. 2003; 64(1): 6-11.

[16] Mahmoud-Ahmed AS, Suh JH. Radiation therapy for Cushing's disease: a review. Pituitary. 2002; 5(3): 175-80.

[17] Kobayashi T, Kida I, Mori Y. Gamma knife radiosurgery in the treatment of Cushing disease: long-term results. J Neurosurg. 2002 Dec; 97(5 Suppl): 422-8.

[18] Inder WJ, Espiner EA, MacFarlane MR. Outcome from surgical management of secretory pituitary adenomas in Christchurch, New Zealand. Intern Med J. 2003 Apr; 33(4): 168-73.

[19] Dickerman RD, Oldfield EH. Basis of persistent and recurrent Cushing disease: an analysis of findings at repeated pituitary surgery. J Neurosurg. 2002 Dec; 97(6): 1343-9.

[20] Kadashev BA, Trunin IK, Kasumova SL, Nersesian GD, Arapova SD. The results of neurosurgical treatment in Itsenko-Cushing's disease [Artículo en ruso]. Zh Vopr Neirokhir Im N N Burdenko. 1997 Oct-Dec; (4): 7-12.

[21] Cannavò S, Almoto B, Dall'Asta C, Corsello S, Lovicu RM, De Menis E et al. Long-term results of treatment in patients with ACTH-secreting pituitary macroadenomas. Eur J Endocrinol. 2003 Sep; 149(3): 195-200.

[22] Blevins LS Jr, Christy JH, Khajavi M, Tindall GT. Outcomes of therapy for Cushing's disease due to adrenocorticotropin-secreting pituitary macroadenomas. J Clin Endocrinol Metab. 1998 Jan; 83(1): 63-7.

[23] Reitmeyer M, Vance ML, Laws ER Jr. The neurosurgical management of Cushing's disease. Mol Cell Endocrinol. 2002 Nov 29; 197(1-2): 73-9.

[24] Welbourn RB. The evolution of transsphenoidal pituitary microsurgery. Surgery. 1986 Dec; 100(6): 1185-90.

[25] Martinez Ruiz M, Gomez Bueno O, Molina Rodriguez MA, Gonzalez Casado I, Gracia Bouthelier R. [Diagnosis, treatment, and long-term outcome in Cushing's disease] [Artículo en español]. An Pediatr (Barc). 2003 Aug; 59(2): 183-6.

[26] Day JD. Surgical approaches to suprasellar and parasellar tumors. Neurosurg Clin N Am. 2003 Jan; 14(1): 109-22.

[27] Nakagawa T, Takashima T, Tomiyama K, Asada M. Approaches to the sella turcica in endoscopic pituitary surgery [Artículo en japonés]. Nippon Jibiinkoka Gakkai Kaiho. 2001 Jan; 104(1): 1-8.

[28] Das K, Spencer W, Nwagwu CI, Schaeffer S, Wenk E, Weiss MH, Couldwell WT. Approaches to the sellar and parasellar region: anatomic comparison of endonasal-transsphenoidal, sublabial-transsphenoidal, and transethmoidal approaches. Neurol Res. 2001 Jan; 23(1): 5-14.

[29] Calvo A, Purriel JA, Bastarrica E, Haberbeck MA. Tumors of the sellar region and the cavernous sinus. Evaluation of diagnostic procedures and therapeutic orientation. Acta Neurol Latinoam. 1980; 26(2): 11-122.

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