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Cushing's disease from an ectopic parasellar adenoma
  1. Philip C Johnston1,
  2. Amir H Hamrahian1,
  3. Robert J Weil2,3
  1. 1Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  2. 2Department of Neurosurgery, The Neurological Institute, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  3. 3Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
  1. Correspondence to Dr Philip C Johnston, Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, 9500 Euclid Avenue Desk F20, Cleveland, Ohio 44195, USA; johnstp{at}ccf.org

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Introduction

Cushing's disease is a result of adrenocorticotropic hormone (ACTH)-dependent hypercortisolism, whereby the majority of cases originate from the pituitary. In rare cases, the source of excess ACTH is from an ectopic pituitary adenoma, in which the clinical and biochemical picture can often be identical to intrasellar corticotroph adenomas.1 Ectopic pituitary adenomas are defined as an adenoma that lies outside the sella and is completely distinct from the normal intrasellar pituitary gland, they can be associated with normal pituitary and in some cases, an empty sella.

Case

A 34-year-old woman presented with a 12-month history of a labile mood, weight gain, easy bruising, irregular menses and hypertension. The patient appeared cushingoid. Biochemical investigations demonstrated hypercortisolism: 24 h urine-free cortisol 520.7 mcg (4–50), …

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