Objective: To report a case of recurrent Cushing's disease after an apparent cure and long-term surveillance.
Methods: We describe in detail the follow-up course of a woman who underwent transsphenoidal resection of a corticotropin-secreting pituitary microadenoma in 1981.
Results: For 2 years postoperatively, the patient exhibited adrenocortical insufficiency. In 1983, the pituitary-adrenal axis was normal. She remained eucorticoid until May 1992, when features of Cushing's syndrome redeveloped. Plasma and urine cortisol and plasma corticotropin levels were once again increased in conjunction with a loss of diurnal variation and abnormal responses to dexamethasone suppression. A magnetic resonance imaging scan of the pituitary gland was consistent with a small lesion on the left side, and petrosal sinus sampling after ovine corticotropin-releasing hormone stimulation was consistent with increased activity on the right side.
Conclusion: This 10-year interval between apparent cure and recurrence appears to be the longest thus far reported for a patient with Cushing's disease. These observations reinforce the impression that permanent cure of this disorder is uncertain and indicate the need for indefinite follow-up.