ACTH - secreting micro adenoma with hypothyroidism - A case report

A 25 year old female was presented with the complaints of weight gain of 15 kg, oligomenorrhea, and hirsutism of 1 year duration. She was known hypertensive. On clinical examination, facial plethora, atrophy of the skin, stria purpurea, hyper pigmented patches over the extremities, over the abdomen, axilla and knees were present, acne was present over the face. On examination, patient was obese; blood pressure (BP) was 150/ 110 mmHg. Bilateral pitting edema was evident and all other systems were normal. On investigations, thyroid stimulating hormone (TSH) and serum cortisol was high. A diagnosis of Cushing’s syndrome with Hypothyroidism was entertained. MRI brain (sella) with contrast revealed pituitary microadenoma. Transsphenoidal excision was done. Histopathology features were consistent with Pituitary Adenoma. Normally Cushing’s syndrome is dependent on ACTH. Pituitary adenoma is present without any physical signs or symptoms. Among them microadenoma is commonly associated with thyrotoxicosis. But this case was presented with hypothyroidism which is very rare.