Female patient with a history of obesity, type 2 diabetes mellitus, hypertension, chronic lung disease associated with smoking and subclinical hypothyroidism.
At 71 years, it was evaluated for poor control of hypertension and diabetes mellitus.
On physical examination, supraclavicular hollow faces were observed.
Urine free cortisol (CLU) was requested: 236 ug/24 h (VN up to 100 ug/24 h), Nugent's test or nocturnal suppression test with dexamethasone (Dx) 1 mg: 11.1 pg/dl.
A functional study was carried out: Dx/ desmopressin test, which showed postprandial cortisol response, suggesting pituitary origin.
Plain MRI was requested, revealing a 6 mm left lateral adenoma, which determines mild sella turcica formation.
For various reasons, the patient did not undergo surgery.
In successive controls normalisation of CLU without treatment was observed.
At 3 years he had a Nugent test of 3.5 ng/dl, ACTH: 54.8 pg/ml and CLU: 50.1 ug/24 h.
A new turcica MRI showed adenoma with similar characteristics, with no evidence of intratumoral hemorrhage.
At 7 years of age has CLU 28.8 ug/24 h, diabetes mellitus maintains adequate control for age (HbA1c: 7.6%) and has decreased 10 kilos of weight since its initial assessment.
Both patients still survive, at 82 and 88 years of age, respectively and do not manifest clinical signs of endocrine hyperfunction.
