{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T00:09:41Z","timestamp":1786234181508,"version":"build-2736575974"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"22","license":[{"start":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T00:00:00Z","timestamp":1701043200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,27]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Double pituitary adenomas are rare presentations of two distinct adenohypophyseal lesions seen in &lt;1% of surgical cases. Increased rates of recurrence or persistence are reported in the resection of Cushing microadenomas and are attributed to the small tumor size and localization difficulties. The authors report a case of surgical treatment failure of Cushing disease because of the presence of a secondary pituitary adenoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>\n                      A 32-year-old woman with a history of prolactin excess and pituitary lesion presented with oligomenorrhea, weight gain, facial fullness, and hirsutism. Urinary and nighttime salivary cortisol elevation were elevated. Magnetic resonance imaging confirmed a 4-mm\n                      <jats:sup>3<\/jats:sup>\n                      pituitary lesion. Inferior petrosal sinus sampling was diagnostic for Cushing disease. Primary endoscopic endonasal transsphenoidal resection was performed to remove what was determined to be a lactotroph-secreting tumor on immunohistochemistry with persistent hypercortisolism. Repeat resection yielded a corticotroph-secreting tumor and postoperative hypoadrenalism followed by long-term normalization of the hypothalamic-pituitary-adrenal axis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case demonstrates the importance of multidisciplinary management and postoperative hormonal follow-up in patients with Cushing disease. Improved strategies for localization of the active tumor in double pituitary adenomas are essential for primary surgical success and resolution of endocrinopathies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23485","type":"journal-article","created":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T19:13:22Z","timestamp":1701112402000},"source":"Crossref","is-referenced-by-count":3,"title":["Consecutive resections of double pituitary adenoma for resolution of Cushing disease: illustrative case"],"prefix":"10.3171","volume":"6","author":[{"given":"Stephanie A","family":"Armstrong","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samon","family":"Tavakoli","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ipsit","family":"Shah","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon R","family":"Laing","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Coss","sequence":"additional","affiliation":[{"name":"Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana G","family":"Ioachimescu","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Department of Medicine, Division of Endocrinology and Molecular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Findling","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology and Molecular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan T","family":"Zwagerman","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Endocr Pathol","first-page":"6","article-title":"Overview of the 2022 WHO Classification of Pituitary Tumors","volume":"33","author":"Asa SL","year":"2022","unstructured":"Asa SL, Mete O, Perry A, Osamura RY. Overview of the 2022 WHO Classification of Pituitary Tumors. Endocr Pathol. 2022;33(1):6\u201326."},{"issue":"5","key":"b2","series-title":"Pituitary","first-page":"472","article-title":"Double separate versus contiguous pituitary adenomas: MRI features and endocrinological follow up","volume":"19","author":"Roberts S","year":"2016","unstructured":"Roberts S, Borges MT, Lillehei KO, Kleinschmidt-DeMasters BK. Double separate versus contiguous pituitary adenomas: MRI features and endocrinological follow up. Pituitary. 2016;19(5):472\u2013481."},{"issue":"4","key":"b3","series-title":"Endocr Pathol","first-page":"332","article-title":"Synchronous multiple pituitary neuroendocrine tumors of different cell lineages","volume":"29","author":"Mete O","year":"2018","unstructured":"Mete O, Alshaikh OM, Cintosun A, Ezzat S, Asa SL. Synchronous multiple pituitary neuroendocrine tumors of different cell lineages. Endocr Pathol. 2018;29(4):332\u2013338."},{"issue":"2","key":"b4","series-title":"J Neurosurg","first-page":"243","article-title":"Multiple adenomas of the human pituitary. A retrospective autopsy study with clinical implications","volume":"74","author":"Kontogeorgos G","year":"1991","unstructured":"Kontogeorgos G, Kovacs K, Horvath E, Scheithauer BW. Multiple adenomas of the human pituitary. A retrospective autopsy study with clinical implications. J Neurosurg. 1991;74(2):243\u2013247."},{"key":"b5","series-title":"Front Endocrinol (Lausanne)","first-page":"1","article-title":"Multiple pituitary adenomas: a systematic review","volume":"7","author":"Budan RM","year":"2016","unstructured":"Budan RM, Georgescu CE. Multiple pituitary adenomas: a systematic review. 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Pituitary. 2019;22(6):620\u2013632."},{"key":"b16","series-title":"World Neurosurg","first-page":"331","article-title":"The intriguing case of a double pituitary adenoma","volume":"126","author":"Gonzalez A","year":"2019","unstructured":"Gonzalez A, Saindane AM, Neill SG, Oyesiku NM, Ioachimescu AG. The intriguing case of a double pituitary adenoma. World Neurosurg. 2019;126:331\u2013335."},{"issue":"7 Pt 1","key":"b17","series-title":"Clin Chem","first-page":"1344","article-title":"Rapid measurement of corticotropin (ACTH) with a modified immunochemiluminescent assay","volume":"40","author":"Raff H","year":"1994","unstructured":"Raff H, Shaker JL, Nelson DK, Findling JW. Rapid measurement of corticotropin (ACTH) with a modified immunochemiluminescent assay. 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