A rare case of Cushing’s disease developing years after Craniopharygioma

Abstract

Abstract Craniopharyngioma (CP) is a rare benign tumor originates from sellar/suprasellar region. It accounts for 1.2–4.6% of all intracranial tumors. Although it is known as childhood disease, it can be diagnosed at all ages. Despite its long-term survival rate is high, the risk of recurrence is also high. There are some treatment options such as radical surgery, radiotherapy and intracystic treatment, but an individualized treatment approach is required. We present a case of craniopharyngioma relapsed as Cushing’s disease (CD). 18-year-old female patient was admitted to hospital 10 years ago with complaints of menstrual irregularities, headaches, nausea, vomiting and visual impairment. Laboratory examination revealed panhypopituitarism. Pituitary magnetic resonance imaging (MRI) showed a 22x13x14 mm mass lesion with solid and cystic components. Transsphenoidal (TS) pituitary surgery was performed. Pathological examination concluded as CP. The patient did not follow up regularly after surgery. Post-operative second year pituitary MRI revealed an empty sella appearance. The patient was admitted with complaints of headache, weight gain and absence of menstrual cycles 8 years after the surgery. Post-operative 8th year pituitary MRI demonstrated a 28x16x18 mm mass lesion that completely filled the sellar cavity and extended to the suprasellar region and both cavernous sinuses. TS pituitary surgery was performed for the second time. Histopathological and immunohistochemical examination showed ACTH-secreting pituitary adenoma. To our knowledge, this is the first case of Cushing's disease developing after years from operation of craniopharyngioma reported in the literature. Finally, long-term follow-up is very important for post-surgical recurrence in patients with sellar region tumors.