MON-093 An Incidental Case Of Cushing's: The Importance Of Evaluating Pituitary Lesions

Abstract Disclosure: M.H. Shafiq: None. S. Haider: None. S. Sheikh: None. S.R. Panja: None. Background: Incidental pituitary lesions are frequently discovered on neuroimaging performed for unrelated symptoms. While often benign, these findings can signify hormonally active adenomas requiring prompt evaluation. This case illustrates how an incidental finding in a patient with nonspecific symptoms led to the diagnosis of Cushing’s disease. Case Presentation: A 34-year-old female with no significant past medical history presented to her primary care provider with persistent sinus headaches. CT imaging incidentally revealed a pituitary lesion measuring 6 × 9.5 × 10 mm, with a solid component measuring 7 × 6 × 3 mm in the right adenohypophysis, suggestive of a microadenoma. She was referred to outpatient endocrinology for further assessment.Upon evaluation, the patient endorsed weight gain, fatigue, elevated blood glucose, and persistent headaches but denied visual disturbances. Endocrine workup revealed an abnormal low-dose dexamethasone suppression test, followed by elevated 24-hour urinary cortisol levels, confirming hypercortisolism. The patient was diagnosed with Cushing’s disease and referred to a tertiary center, where she underwent successful transsphenoidal resection at MD Anderson Cancer Center.At present the patient is on 15mg of hydrocortisone per day. After surgery, her weight decreased from 227lb to 150lb. Discussion: This case highlights the clinical importance of thoroughly evaluating incidental pituitary lesions, especially in the presence of subtle or common symptoms such as fatigue and weight gain. Failure to investigate hormonal activity may delay the diagnosis of conditions like Cushing’s disease, which can carry significant morbidity if untreated. Conclusion: Incidental pituitary lesions require careful endocrine evaluation. Simply evaluating prolactin is insufficient. This case reinforces the need for a high index of suspicion and a structured diagnostic approach to prevent missed diagnoses of functional pituitary adenomas. Presentation: Monday, July 14, 2025