Double
pituitary adenomas are rare occurrences in autoptical, surgical and neuroradiological series and are mostly due to non-functioning
pituitary adenomas, GH-secreting and
prolactin-secreting
adenomas.
ACTH secreting tumours are more rare and, to our knowledge, two distinct
ACTH-producing
adenomas within the same pituitary have never been reported. We herewith describe a 56 year old woman with
Cushing' s disease due to two clearly distinct
ACTH-secreting pituitary adenomas. She presented with signs and symptoms of
hypercortisolism and hormonal testing was indicative for pituitary-dependent
Cushing' s syndrome. Sellar MRI visualized an asymmetric pituitary gland with suspect lesions in both the right and the left pituitary lobes. Both lesions were removed during transsphenoidal surgery and remission of
hypercortisolism ensued. Pathology confirmed the existence of two distinct
adenomas located in different sites in the gland. Both presented
ACTH immunoreactivity but displayed distinct morphological features. Our case indicates that double
ACTH-secreting pituitary adenomas may occur in patients with
Cushing' s disease. Careful radiological, surgical and pathological examination is necessary to recognize this condition and avoid surgical failure.