Recurrent cavernous sinus thrombosis: a rare complication of Cushing disease

A 14-year-old girl who presented in 2017 with headache, unilateral right eye ptosis and secondary amenorrhoea had an initial workup consistent with non-functioning pituitary macroadenoma. She underwent debulking of pituitary tumour in October 2017. Postoperatively, she developed recurrent cavernous...

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Published inBMJ case reports Vol. 14; no. 6; p. e243786
Main Authors Tong, Chin Voon, Tee, Chee Kit
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 22.06.2021
BMJ Publishing Group
Subjects
Adenoma
Adolescent
Anticoagulants
Blood pressure
Case Report
Case reports
Cavernous Sinus Thrombosis
Cushing syndrome
Diabetes
Female
Headaches
Hormones
Humans
Hypertension
Metabolic syndrome
Neoplasm Recurrence, Local - complications
Patients
Pediatrics
Pituitary ACTH Hypersecretion - complications
Pituitary Neoplasms - complications
Pituitary Neoplasms - diagnostic imaging
Pituitary Neoplasms - surgery
Pulmonary embolisms
Radiation therapy
Sinuses
Surgery
Thrombosis
Tumors
neuroendocrinology
paediatrics (drugs and medicines)
pituitary disorders
neurology
endocrinology
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Summary:A 14-year-old girl who presented in 2017 with headache, unilateral right eye ptosis and secondary amenorrhoea had an initial workup consistent with non-functioning pituitary macroadenoma. She underwent debulking of pituitary tumour in October 2017. Postoperatively, she developed recurrent cavernous sinus thrombosis. In view of recurrent thrombosis, she was reinvestigated and was found to have adrenocorticotropic hormone-dependent Cushing. Follow-up MRI 1 year after initial presentation showed that there was structural recurrence of pituitary macroadenoma. She subsequently underwent a petrosal craniotomy for debulking of tumour. Postsurgery she remained biochemically Cushingnoid. MRI 5 months after second surgery showed an enlarging pituitary mass which was deemed inoperable. A multidisciplinary meeting discussion consensus for treatment included radiotherapy and somatostatin analogue, pasireotide. She completed 30 cycles of radiotherapy and MRI post radiotherapy showed reduction in the size of the macroadenoma. Currently, she is waiting for pasereotide initiation.
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ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2021-243786