Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access
Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc
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Case Report

Volume 12, Number 1, February 2022, pages 40-48

Cushing’s Disease of Unknown Etiology: A Clinical Case Report


Figure 1.
Figure 1. Physical habitus of patient.
Figure 2.
Figure 2. First MRI study showing diffuse enlargement of the whole pituitary gland. MRI: magnetic resonance imaging.
Figure 3.
Figure 3. Pathologic sample removed at surgery. (a) Pituitary adenoma solid pattern, with cells with clear or eosinophilic cytoplasm (hematoxylin and eosin stain, × 200). (b) Scarcity of the reticulin net (Gomori stain × 200). (c) ACTH immunostain (× 200). ACTH: adrenocorticotropic hormone.
Figure 4.
Figure 4. Last MRI study with marked widening of the pituitary stalk. MRI: magnetic resonance imaging.


Table 1. Circadian Rhythm and Rapid Overnight Dexamethasone (1.0 mg PO at 24 h) Test
9 h19 h24 h8 h (post Dex)
ACTH: adrenocorticotropic hormone; PO: orally; Dex: dexamethasone.
ACTH (pg/mL)48363217
Cortisol (µg/dL)2014149


Table 2. Prolonged Low (Dexamethasone 0.5 mg 6/6 h for 48 h) and High (Dexamethasone 2 mg 6/6 h for 48 h) Tests
24 h48 h72 h96 h
ACTH: adrenocorticotropic hormone.
ACTH (pg/mL)3446812
Cortisol (µg/dL)8150.70.7


Table 3. CRH Test (hCRH 100 µg, IV, Bolus at Time 0)
0 min5 min10 min15 min30 min60 min120 min
IV: Intravenous; CRH: corticotropin-releasing hormone; ACTH: adrenocorticotropic hormone.
ACTH (pg/mL)44394247577057
Cortisol (µg/dL)32292829313533