Different imaging characteristics of concurrent pituitary adenomas in a patient with Cushing's disease

Gautam U. Mehta, Blake K. Montgomery, Pooja Raghavan, Susmeeta Sharma, Lynnette K. Nieman, Nicholas Patronas, Edward H. Oldfield, Prashant Chittiboina

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


We report a patient with Cushing's disease (CD) and two pituitary adenomas that demonstrated different imaging characteristics and therefore suggest an alternative imaging strategy for these patients. A 42-year-old woman presented with signs and symptoms of CD. Biochemical evaluation confirmed hypercortisolemia and suggested CD. On pituitary MRI with spoiled gradient recalled acquisition in the steady-state and T1-weighted spin echo protocols, a 5 mm hypoenhancing region typical for a pituitary adenoma was identified on the left. However, after surgical resection the patient remained hypercortisolemic and pathology revealed a non-functional adenoma. At early repeat surgical exploration a 10 mm adenoma was found in the right side of the gland. Postoperatively the patient became hypocortisolemic and pathology demonstrated an adrenocorticotropic hormone (ACTH)-staining adenoma. On review of the initial MRI this tumor corresponded to a region of contrast retention best visualized on delayed fluid attenuated inversion recovery (FLAIR) imaging. While the incidentaloma in this case demonstrated classical imaging characteristics of a pituitary adenoma the larger ACTH-secreting tumor was best appreciated by contrast retention. This suggests a role for delayed postcontrast FLAIR imaging in the preoperative evaluation of CD. ACTH-secreting tumors causing CD cause significant morbidity. Due to their small size, a pituitary adenoma is frequently not identified on imaging despite endocrinologic testing suggesting CD. Regardless of improvements in MRI, many tumors are only identified at surgical exploration.

Original languageEnglish
Pages (from-to)891-894
Number of pages4
JournalJournal of Clinical Neuroscience
Issue number5
StatePublished - May 1 2015


  • Cushing's disease
  • Delayed MRI
  • Fluid attenuated inversion recovery imaging
  • Pituitary adenoma
  • Transsphenoidal surgery


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