Abstract
We are describing the case of a 13-year-old girl with Cushing's disease by ACTH-secreting pituitary microadenoma. At the time of diagnosis there were only initial symptoms present: development of moon face, hirsutism; no obesity nor striae.
Among the first symptoms which led us to the diagnosis of the disease were: muscle weakness, mental problems including depression, and sleeping disorder. The most significant features were mucosal candidiasis as the result of immunosuppression with hypercortisolemia and many haematomas on the body surface.The suppressive effect of hypercortisolemia on the hypothalamus-hypophysis-gonads system was manifested as a central isosexual puberty block.
The growth retardation caused by the suppression of growth hormone-IGF-I (insulin-like growth factor 1) system was present two years before the clinical symptoms were manifested. The recurrence of the disease came two years after the first surgery.
The second surgery was not successful. Now, the patient is one year after irradiation of the adenoma's residuum by the Leksell gamma knife.
We are suppressing steroidogenesis through combined adrenolytic and neuromodulating therapy until the irradiation curative effect sets on.