MON-086 Acromegaly Meets Cushing’s Disease in One Patient: A Case Report

Abstract Disclosure: E. Yılmaz: None. M. Takır: None. Background: The occurence of two pituitary adenomas in one single patient is a rare clinically condition with a prevalance of 0.2-2.6 % among pituitary adenomas. Missing the second lesion leading to incomplete biochemical remission after surgery. Clinical Case: A 31-year-old woman presented with weight gain,mentrual irregularity,hirsutism and galactorrhea. Endocrine evaluation revealed ACTH-dependent hypercortisolemia and elevated 24-hour urinary cortisol (399,8,275 N<82). There was no supression in 1mg, 2mg dexamethasone suppression tests (8 am cortisol 14.9,13.53). In the 8mg dexamethasone suppression test, 50% supression compared to basal cortisol was supportive of Cushing’s disease Magnetic resonance imaging (MRI) of the sella demonstrated a 1.2*1.2*0,9 cm pituitary adenoma. Except for mild hyperprolactinemia IGF-1 and other anterior pituitary hormones were within normal range.There were no clinical findings of acromegaly at first admission. Transsphenoidal surgery was performed. Immunohistochemical staining (IHC) was positive for ACTH, but negative for growth hormone (GH). After surgery hypercortisolemia resolved, and no residue was detected in the MRI. After 5 years, a change in the patient’s facial appearance and an increase in the size of the hands and feet were detected IGF-1 was 494,82 (N:130-354 ) and did not supress after glucose administration. MRI revealed a 5*6 mm sized adenoma on the left side. Second transsphenoidal surgery were performed. IHC was positive for GH but negative for ACTH. After surgery IGF-1 returned to normal. Conclusion: However to our knowledge this is the third case of Cushings’ Disease and acromegaly resulting from double adenomas of the pituitary gland; unlike previous cases, there is along period of time between the appearance of two clinic situation. Extensive surgery must be perform to avoid residual tumor. Postoperative immunohistochemical analysis is required to confirm exact diagnosis. According to us post-surgical follow-up is important. Presentation: Monday, July 14, 2025