Cyclical Cushing's disease with a remission of more than 10 years

A patient with cyclical Cushing's disease due to an AGTH-producing pituitary microadenoma with symptoms disappearing and reappearing over a period of more than 10 years is presented. The patient was first seen when he was 13 years of age. An elevated plasma cortisol concentration (34 mu g/dL) was documented, but the patient was lost to follow up. His symptoms gradually disappeared over a period of 2 years. Fifteen years later, the patient, then 28 years old, presented with severe physical stigmata of hypercortisolism, which had developed gradually during the previous 2 years. After biochemical confirmation of ACTH-dependent Cushing's syndrome, the patient underwent successful transsphenoidal pituitary surgery, revealing a 5 mm microadenoma. One year after the operation, the patient remains in remission without the need of any replacement therapy. This patient, therefore, suffered from cyclical Cushing's disease with symptoms disappearing and reappearing over a period of more than 10 years.