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Journal of Clinical Endocrinology & Metabolism, Vol 52, 95-97, Copyright © 1981 by Endocrine Society

ARTICLES

Silent pituitary apoplexy: subclinical infarction of an adrenocorticotropin-producing pituitary adenoma

JW Findling, JB Tyrrell, DC Aron, PA Fitzgerald, CB Wilson and PH Forsham

A young woman developed intermittent headaches and progressive hyperpigmentation after bilateral adrenalectomy for Cushing's disease. Results of sellar polytomography were abnormal. Her plasma ACTH levels increased to 4750-7340 pg/ml and did not rise with insulin-induced hypoglycemia. Although she experienced no clinical features associated with spontaneous infarction of a pituitary tumor, plasma ACTH levels fell to 474-575 pg/ml, and hemorrhagic necrosis was found in a 5-mm chromophobe adenoma at transsphenoidal surgery. Postoperatively, ACTH levels returned to normal (51-88 pg/ml), with the rest of her anterior pituitary function remaining intact 4 yr later. Spontaneous infarction of pituitary microadenomas may be subclinical, resulting in improvement of pituitary hormone hypersecretion without impairment of other anterior pituitary hormone secretion.


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