Clinical management challenges of Cushing's disease associated with double pituitary adenomas: four cases and literature review.
Preoperative magnetic resonance imaging detected both pituitary adenomas in only 16.7% of patients
Clinical management challenges of Cushing's disease associated with double pituitary adenomas: four cases and literature review.
To characterize clinical, radiological, and pathological features of double pituitary adenomas (double pituitary adenomas) involving a corticotroph adenoma and evaluate challenges associated with preoperative localization and surgical management of Cushing's disease (CD).
We retrospectively reviewed four institutional cases and searched PubMed and Web of Science (1990-2025), identifying 30 publications comprising 68 additional cases.
Magnetic resonance imaging localized both tumors in only a minority of patients
Follow-up pituitary magnetic resonance imaging (magnetic resonance imaging) demonstrated a second suspected lesion in all four patients.
In Cases 3 and 4, magnetic resonance imaging abnormalities were subtle or equivocal, and 68 Ga-pentixafor positron emission tomography/computed tomography (PET/CT) revealed concordant focal uptake at the suspected sites.
Revision transsphenoidal surgery confirmed an adrenocorticotropic hormone (adrenocorticotropic hormone)- and T-PIT-positive corticotroph adenoma in all four patients, and all achieved early postoperative biochemical remission.
Sixteen patients (22.2%) underwent repeat surgery, whereas surgical-course information was unavailable in 21 (29.2%).
Double pituitary adenomas involving a corticotroph component should be considered as a possible explanation for persistent hypercortisolism after transsphenoidal surgery when the resected lesion is negative for adrenocorticotropic hormone and T-PIT.
Multidisciplinary reassessment and repeat expert pituitary imaging review may help identify an additional lesion. The role of adjunctive molecular imaging remains preliminary.