Recurrent pituitary Cushing’s disease with post-radiotherapy panhypopituitarism: An 18-year case follow-up

Abstract

Cushing’s disease (CD) is a form of Cushing’s syndrome, caused by an adrenocorticotropic hormone-secreting pituitary tumor. CD typically presents as weight gain, headache, and fatigue, and is associated with hypertension, diabetes mellitus, and psychiatric disorders. Transsphenoidal surgery (TSS) is the primary treatment, though relapse occurs in up to 18% of patients, typically within 4 years. We present a woman in her late 40s with a long-standing CD who initially achieved biochemical remission following TSS. However, she experienced an early recurrence within 3 months. Post-operative magnetic resonance imaging showed an empty sella with a small enhancing focus, suggestive of residual disease. She declined repeat surgery and underwent stereotactic radiotherapy, conventional radiotherapy, and medical therapies. These failed to maintain remission, and she subsequently developed hypopituitarism following radiotherapy. This case illustrates the chronic nature of CD and the risk of early recurrence despite remission. Managing recurrent CD is complex and requires an individualized, multidisciplinary approach that integrates psychosocial and medical care to optimize outcomes.