Significant hypercortisolism during fractionated radiotherapy in a patient with a large corticotroph adenoma: a case report and literature review.

Abstract

OBJECTIVE:

We describe a patient with a large, invasive corticotroph adenoma who developed severe hypercortisolism shortly after starting fractionated radiotherapy.

METHODS:

We reviewed the patient's clinical course, along with relevant literature for similar reported cases.

RESULTS:

A 29-year-old man was referred for radiotherapy for a residual and recurrent, invasive corticotroph adenoma. Prior to radiotherapy, he had a normal urine free cortisol (UFC) level of 44.7 μg/24 hours, with minimal symptoms. Within 2 weeks of radiotherapy, he developed hypertension, ankle edema, and hypokalemia (potassium level, 2.8 mEq/L), with a markedly elevated UFC level of 9,203 μg/24 hours. His UFC gradually decreased and normalized by the end of radiotherapy. One month later, the patient became adrenal insufficient, with a nondetectable 24-hour UFC. His adrenal function slowly recovered in 3 months. We are aware of only one previous case report of clinically significant hypercortisolism following radiotherapy in Cushing disease.

CONCLUSION:

Radiotherapy may result in acute severe hypercortisolism in patients with a large corticotroph adenoma. This uncommon, but clinically significant, acute adverse effect of radiotherapy suggests that clinical observation and biochemical monitoring during or soon after radiotherapy may be indicated.

• Authors: Soamsiri Niwattisaiwong, John H Suh, Robert J Weil, Amir H Hamrahian
• Journal: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists (Endocr Pract) Vol. 20 Issue 9 Pg. e166-70 (Sep 2014) ISSN: 1530-891X [Print] United States
• PMID: 24936553 (Publication Type: Journal Article)