Graves disease exacerbation after pituitary adenomectomy for cushing disease resulting in an adrenal crisis

Mehmet K. Aktas, Maria Fleseriu, Robert J. Weil, Charles Faiman, Orlin T. Sergev, Sethu Reddy, Amir H. Hamrahian

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To describe a patient with Cushing disease who had an exacerbation of Graves disease following surgical resection of a corticotroph pituitary adenoma. METHODS: We present the clinical and biochemical findings of this case, with review of the pertinent literature. RESULTS: A 39-year-old woman with a history of Graves disease on methimazole presented with a 100-pound weight gain over 12 months. Biochemical evaluation revealed Cushing disease, and she underwent an uncomplicated trans-sphenoidal pituitary adenomectomy surgery. Seven weeks after operation, she presented with an adrenal crisis, despite taking 30 mg of hydrocortisone daily, as a likely consequence of worsening hyperthyroidism despite continued methimazole treatment. CONCLUSION: A combination of Graves disease and Cushing syndrome can be a challenging scenario. Successful treatment of hypercortisolism can lead to an exacerbation of hyperthyroidism, with a resultant increase in cortisol clearance, which, in this circumstance, may precipitate an adrenal crisis. Clinicians should be aware of these interactions and monitor such patients closely.

Original languageEnglish (US)
Pages (from-to)206-208
Number of pages3
JournalEndocrinologist
Volume17
Issue number4
DOIs
StatePublished - Jul 1 2007
Externally publishedYes

Keywords

  • Adrenal crisis
  • Adrenal insufficiency
  • Cushing disease
  • Graves disease
  • Pituitary surgery

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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