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6 F2 / F15 / + - &*. /01 *. *2 % -+ %" $j O% D " $% )% S3 4.% 1Q '( 1NE+ '( &% > %" % O%; $+% &?3% -@; &R 5; & > %" 1N % /GM23 5; $ &R \M.% b:; O T 3 ':+" % YO Ç %4 / ':+" -+ 6% & SD /4 9:;.%%Q $% 9:; % O T ; % > %" /3O%; 0+.(15) $F43 O%; SWZW /3;.%% 43 D " 1 9:; % K6 D " %87 % 3".4W 4 3 Q0 /3O%; 4W :43 t : /3O%; Q % -+ 4 % -+ % 5; &R $4 -+ % T;; 3 b:; ':+".1Q4 %" X; &Å3 Y1Q % %" -+ O ^Q % 5; /4 G $4 $% kq % %" % $ $;4 YO% :'$( 1- Kronenberg HM, Melmed S, Polonsky K, Larsen P. Williams Text book of Endocrinology. 11 th ed. Philadelphia: Saunders; pp: Nieman LK. Diagnostic Tests for Cushing's Syndrome. Annals of the New York Academy of Sciences. 2002; 970: Yoshihara A, Okubo Y, Tanabe A, Sata A, Nishimaki M, Kawamata T, et al. A Juvenile Case of Cushing's Disease Incidentally Discovered with Multiple Bone Fractures. Int Med. 2007; 46 (9): Kasper DL, Braunwald EA, Fauci S. Hauser SL, Longo DL, Jameson JL. Harrison s Principles of Internal Medicine 16 th ed. USA: McGraw-Hill; pp: Chen JC, Amar AP, Choi S, Singer P, Couldwell WT, Weiss MH. Transsphenoidal microsurgical treatment of Cushing disease: postoperative assessment of surgical efficacy by application of an overnight low-dose dexamethasone suppression test. J Neurosurg. 2003; 98 (5): Weil RJ, Vortmeyer AO, Nieman LK, Devroom HL, Wanebo J, Oldfield EH. Surgical remission of pituitary adenomas confined to the neurohypophysis in Cushing's disease. J Clin Endocrinol Metab. 2006; 91 (7): Hammer GD, Tyrrell JB, Lamborn KR, Applebury CB, Hannegan ET, Bell S, et al. Microsurgery for Cushing s disease: initial outcome and long-term results. J Clin Endocrinol Metab. 2004; 89: Oldfield EH, Cushing s disease. J Neuro Surg. 2003; 98: Shirvani M. Results of trans-sphenoidal surgery in 29 cases of Cushing s disease. Pajouhandeh Quarterly Res J. 2004; 36 (8): Bahrami A, Abed Moghaddam AR. Long-term results of bilateral adrenalectomy for Cushing s disease. Iranian J Endocrin Metabol. 2004; 23 (6): Nagesser SK, van Seters AP, Kievit J, Hermans J, Krans HM, van de Velde CJ. Long-term results of total adrenalectomy for Cushing's disease. World J Surg. 2000; 24 (1): Mampalam TJ, Tyrrell JB, Wilson CB. Transsphenoidal microsurgery for Cushing disease. A report of 216 cases. Ann Intern Med. 1988; 109 (6): Burke CW, Adams CB, Esiri MM, Morris C, Bevan JS. Transsphenoidal surgery for Cushing s disease: does what is removed determine the endocrine outcome? Clin Endocrinol (Oxf) 1990; 33 (4): Doppman JL, Miller DL, Dwyer AJ, Loughlin T, Nieman L, Cutler GB, Chrousos GP, Oldfield E, Loriaux DL, Macronodular Adrenal Hyperplasia in Cushing Disease. Radiology. 1988; 166: Haaga JR; Lanzieri CF, Gilkeson RC. CT and MR Imaging of the Whole Body. 4 th ed. St.Louis: Mosby;

7 Title: Inappropriate unilateral adrenalectomy in two cases of Cushing s disease (Pituitary adenoma) Authors: S. Kalbasi 1, H. Akhbari 2, F. Sharifi Mood 3 Abstract Cushing s syndrome which is an uncommon but lethal disorder occurs due to many causes. The most common endogenous cause is Cushing s disease or pituitary Cushing. The etiology of this disorder is an adenoma in the anterior pituitary. The most important point in the treatment of this disorder is differentiation between Cushing s disease (pituitary) and Cushing s syndrome (adrenal). We can differentiate up to 90% of cases with hormonal test and radiologic anatomy.the incidence ratio of the disorder in females to males is approximately 5:1. Bilateral adrenal hyperplasia, which is seen in Cushing s disease, is caused by long adrenocorticotropic hormone (ACTH) secretion. This long acting secretion may cause formation of nodules in adrenals. Sometimes these unilateral nodules may cause misdiagnosis. In this article, two cases of cushing s disease which had been misdiagnosed and led to unilateral adrenalectomy are reported. These surgeries were not effective and after proper hormonal tests approving occurrence of Cushing s disease, both cases had Trans-Sphenoidal Surgery (TSS). After surgery the symptoms in the cases decreased. But both patients had a recurrence of the disease. Now, by means of radiotherapy and medical adrenalectomy (ketoconazole treatment) both of them are under control. Key Words: Cushing s syndrome; Cushing s disease; Adrenalectomy; Trans- Sphenoidal Surgery (TSS) 1 Corresponding author; Assistant Professor, Department of Internal Medicine, Faculty of Medicine, Member of Diabetes Research Centre, Birjand University of Medical Sciences, Birjand, Iran. saeid_kalbasi@yahoo.com 2 Associate Professor, Department of Internal Medicine, Faculty of Medicine, Member of Diabetes Research Centre, Birjand University of Medical Sciences, Birjand, Iran. 3 Student of Medicine, Birjand University of Medical Sciences, Birjand, Iran 98

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