LACK OF EFFECT OF HYPOPHYSECTOMY UPON METASTATIC ADRENOCORTICAL CARCINOMA WITH CUSHING'S SYNDROME: A CASE REPORT*

Abstract

This report descr. a 26-yr.-old man with metastatic adrenocortical carcinoma, accompanied by typical Cushing''s syndrome. No significant change in the clinical picture occurred after complete removal of the pituitary, with the exception of the appearance of a state resembling mild diabetes insipidus. No steroid replacement therapy was given subsequent to the 1st wk. after hypophysectomy. Nevertheless, the severe diabetes mellitus, normal serum electrolyte values or values suggesting hypochloremic alkalosis, markedly elevated urinary excretion of 17-ketosteroids and corticoids, and the preexisting psychosis all persisted essentially unchanged. Death occurred 7 wks. after extirpation of the pituitary. Autopsy confirmed the completeness of the hypophysectomy and demonstrated moderate atrophy of the target endocrine glands[long dash]thyroid, testes, and remaining adrenal. Metastatic malignant tissue was widespread.