Diagnosis and management of Cushing's disease with normal MR finding

Objective To discuss the diagnosis and managmental principle of Cushings disease with normal MR finding. Methods Clinical data of 36 cases of Cushings disease with normal MR finding were analyzed retrospectively.Besides one Nelson syndrome case,the other 35 patients had typical clinical manifestations of hypercorticoidism.Endocrinological assessment supported the diagnosis of Cushings disease in 31,the other 5 cases had atypical endocrine data.All patients were treated by transsphenoidal pituitary exploration. The follow up period ranged from half a year to 4 years(average 1 5 yrs). Results Pathological examination confirmed pituitary ACTH adenoma in 27,pituitary ACTH cell hyperplasia in 4,no evidence of adenoma or hyperplasia in 5 cases.Combined with endocrinological results and clinical features,the curative and remissive ratio was 67% and 19% respectively in our study. Conclusions For patients of Cushings disease with normal MR finding, transsphenoidal pituitary exploration could be used if the patient have typital clinical and endocrinological features.Patients with atypical endocrine data have relative surgical indication so if ectopic ACTH secreting adenoma could be excluded.