Cushing Syndrome Case File

https://medical-phd.blogspot.com/2021/03/cushing-syndrome-case-file.html

Authors: Eugene C.Toy, MD, William E. Seifert, Jr., PHD, Henry W. Strobel, PHD,
Konrad P. Harms, MD

❖ CASE 50
A 32-year-old woman presents to her obstetrician/gynecologist with complaints of
irregular periods, hirsutism, and mood swings. She also reports weight gain and easy
bruising. On examination, she is found to have truncal obesity, a round “moon” face,
hypertension, ecchymoses, and abdominal striae. The patient is given a
dexamethasone suppression test which reveals an elevated level of cortisol.

◆ What is the likely diagnosis?

◆ What would an elevated adrenocorticotropic hormone (ACTH) level indicate?

ANSWERS TO CASE 50: CUSHING SYNDROME

Summary: A 32-year-old female with irregular menses, hirsutism, mood swings,

weight gain, truncal obesity, hypertension, abdominal striae, ecchymoses, and
elevated cortisol levels.

◆ Diagnosis: Cushing Syndrome

◆ Elevated ACTH level: Likely cause of adrenal hyperplasia from. ACTH-

producing tumor

CLINICAL CORRELATION
This patient presents with many of the classic findings of Cushing syndrome. Adrenal
hyperplasia can be caused by excessive stimulation from ACTH (pituitary or ectopic
production) or from a primary adrenal problem such as adenomas/ carcinomas. In
addition to above symptoms, patients with Cushing syndrome are also at risk for
osteoporosis and diabetes mellitus (DM). The diagnosis is confirmed with elevated
cortisol levels after a dexamethasone suppression test. Treatment depends on the
underlying etiology and is often surgical.

Definitions
Abdominal striae: Stretch marks of the abdominal region.
ACTH (adrenocorticotropic hormone or corticotropin): Hormone produced in the
anterior pituitary, which stimulates adrenal production of cortisol.
Adenoma: Any benign tumor of glandular origin; typically found in the adrenal,
pituitary, and thyroid glands (note: once an adenoma has progressed to malignancy, it
is referred to as an adenocarcinoma).
CRH (corticotropin-releasing hormone): Hormone produced in the hypothalamus,
which stimulates release of ACTH from the anterior pituitary.
Cushing disease: A specific form of Cushing syndrome, which is caused by an
ACTH-secreting pituitary adenoma; represents approximately 66 percent of all cases
of Cushing syndrome. Because of structural similarities with melanocyte-stimulating
hormone (MSH), excess ACTH from pituitary adenomas can induce dermal
hyperpigmentation.
Dexamethasone suppression test: An overnight test used to screen patients for
Cushing syndrome by administering dexamethasone to a patient. Positive results for
this test are indicated by a patient’s inability to reduce cortisol levels after
dexamethasone treatment—usually because the patient’s feedback loop mechanism is
ineffective at inhibiting cortisol release.
Ecchymosis: Bruise or contusion; normally comes from damage to the capillaries at
the site of injury, allowing blood to seep out into the surrounding tissue, presenting
initially as a blue or purple color.
Ectopic ACTH syndrome: Form of Cushing syndrome in which benign or malignant
tumors arise in places other than the pituitary, leading to excessive release of ACTH
and subsequently, cortisol into the bloodstream; represents approximately 10 to 15
percent of Cushing syndrome cases.
Hirsutism: Increased presence of hair in women on body regions where hair does not
normally grow.
Hypercortisolism: A condition in which the body is exposed to an excess of cortisol
for an extended period of time.
Iatrogenic Cushing syndrome: Condition in which all symptoms of Cushing
syndrome are brought on by administration of synthetic forms of cortisol, such as
prednisone and dexamethasone. “Iatrogenic” originates from Greek and literally
translates to mean “born from” the “healer.”
Pseudo-Cushing syndrome: Condition in which alcohol induces symptoms of
Cushing syndrome without the tumor that leads to increased cortisol levels.