Refractory hypokalaemia and hypertension with metabolic alkalosis: an acute presentation of Cushing’s disease secondary to a pituitary macroadenoma

2021 ◽  
Vol 14 (8) ◽  
pp. e244850
Author(s):  
Najeeb Zaheer Shah ◽  
Shah Malik ◽  
Thozhukat Sathyapalan ◽  
Kamrudeen Mohammed
Keyword(s):  
Metabolic Alkalosis ◽  
Adrenocorticotropic Hormone ◽  
Urinary Free Cortisol ◽  
Clinical Findings ◽  
Ultrasound Scan ◽  
Oral Antibiotics ◽  
Acute Presentation ◽  
Intravenous Antibiotics ◽  
Free Cortisol ◽  
Proximal Myopathy

A 68-year-old woman presented with right arm cellulitis, not responsive to oral antibiotics. Intravenous antibiotics were commenced, and an ultrasound scan confirmed a collection that was surgically drained. She developed refractory hypokalaemia with normal magnesium, no gastrointestinal losses and no iatrogenic cause. She was hypertensive, hyperglycaemic, alkalotic, clinically obese with proximal myopathy and skin bruising. These clinical findings and refractory hypokalaemic hypertension with metabolic alkalosis raised a suspicion of Cushing’s syndrome (CS). 24-hour urinary free cortisol (24 hours) was grossly raised on two occasions. The adrenocorticotropic hormone (ACTH) was significantly raised at 154 ng/L, confirming ACTH-dependant CS. A CT scan of the thorax, abdomen and pelvis excluded an ectopic source of hypercortisolaemia. MRI pituitary revealed an invasive macroadenoma. Treatment with endoscopic debulking resulted in the resolution of hypokalaemia and metabolic alkalosis with significant improvement in hyperglycaemia and hypertension.

scholarly journals A Retroperitoneal Leiomyosarcoma Presenting as an Adrenal Incidentaloma in a Subject on Warfarin

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Ishrat N. Khan ◽  
Mohamed A. Adlan ◽  
Michael J. Stechman ◽  
Lakdasa D. Premawardhana
Keyword(s):  
Left Kidney ◽  
Adrenal Incidentaloma ◽  
Urinary Free Cortisol ◽  
Adrenal Haemorrhage ◽  
Acute Presentation ◽  
Clinically Normal ◽  
Free Cortisol ◽  
Mri Scans ◽  
17 Hydroxyprogesterone ◽  
Normal Ultrasound

Adrenal incidentalomas (AIs) are mostly benign and nonsecretory. Management algorithms lack sensitivity when assessing malignant potential, although functional status is easier to assess. We present a subject whose AI was a retroperitoneal leiomyosarcoma (RL).Case Presentation. A woman on warfarin with SLE and the antiphospholipid syndrome, presented with left loin pain. She was normotensive and clinically normal. Ultrasound scans demonstrated left kidney scarring, but CT scans revealed an AI. MRI scans later confirmed the AI without significant fat and no interval growth. Cortisol after 1 mg dexamethasone, urinary free cortisol and catecholamines, plasma aldosterone renin ratio, and 17-hydroxyprogesterone were within the reference range. Initially, adrenal haemorrhage was diagnosed because of warfarin therapy and the acute presentation. However, she underwent adrenalectomy because of interval growth of the AI. Histology confirmed an RL. The patient received adjuvant radiotherapy.Discussion. Our subject presented with an NSAI. However, we highlight the following: (a) the diagnosis of adrenal haemorrhage in this anticoagulated woman was revised because of interval growth; (b) the tumour, an RL, was relatively small at diagnosis; (c) this subject has survived well over 60 months despite an RL perhaps because of her acute presentation and early diagnosis of a small localised tumour.

Hormone Studies in a Case of Virilisation Due to Ovarian Tumour

1985 ◽  
Vol 22 (5) ◽  
pp. 498-501 ◽  
Author(s):  
J A Fleetwood ◽  
M J Watson ◽  
Hilary J Wastell ◽  
Ann Weddell
Keyword(s):  
Mucinous Cystadenoma ◽  
Urinary Free Cortisol ◽  
Ovarian Tumour ◽  
Plasma Testosterone ◽  
Ultrasound Scan ◽  
Ovarian Mass ◽  
Serum Lh ◽  
Free Cortisol ◽  
Before And After ◽  
Leydig Cell Tumour

The investigation is described of a 62-year-old female patient who presented with severe virilisation; her plasma testosterone concentration was grossly elevated at 37–9 nmol/L. Measurement of plasma androstenedione, dehydroepiandrosterone (DHEA) and DHEA-sulphate, urinary 17-oxosteroids and urinary ‘free’ Cortisol suggested an ovarian source of androgens. An ultrasound scan indicated the presence of an ovarian mass which was removed and classified as a Sertoli—Leydig cell tumour (arrhenoblastoma) combined with a mucinous cystadenoma. Following operation plasma testosterone levels returned to normal. The excessive pre-operative testosterone production appeared to have had little effect on the plasma level of SHBG, since levels remained similar before and after removal of the tumour. Serum LH and FSH levels were higher post-operatively.

How useful is 24 hour Urinary Free Cortisol as a screening tool for Cushing's syndrome?

2018 ◽  
Author(s):  
Ahmed Hanafy ◽  
Chinnadorai Rajeswaran ◽  
Saad Saddiq ◽  
Warren Gillibrand ◽  
John Stephenson
Keyword(s):  
Cushing’S Syndrome ◽  
Screening Tool ◽  
Urinary Free Cortisol ◽  
Cushing's Syndrome ◽  
Free Cortisol

A Comparative Study of Urinary 17-Hydroxycorticosteroids, Urinary Free Cortisol, and the Integrated Concentration of Plasma Cortisol*

1980 ◽  
Vol 51 (5) ◽  
pp. 1099-1101 ◽  
Author(s):  
ZVI ZADIK ◽  
LUIZ DE LACERDA ◽  
LUIZ A. H. DE CARMARGO ◽  
BRUCE P. HAMILTON ◽  
CLAUDE J. MIGEON ◽  
...  
Keyword(s):  
Comparative Study ◽  
Plasma Cortisol ◽  
Urinary Free Cortisol ◽  
Free Cortisol

THE EFFECTS OF DEXAMETHASONE AND ANDROGENS ON SEXUAL RECEPTIVITY OF FEMALE RHESUS MONKEYS

1971 ◽  
Vol 51 (3) ◽  
pp. 575-588 ◽  
Author(s):  
B. J. EVERITT ◽  
J. HERBERT
Keyword(s):  
Rhesus Monkeys ◽  
Testosterone Propionate ◽  
Secretory Activity ◽  
Urinary Free Cortisol ◽  
Sexual Receptivity ◽  
Adrenal Androgens ◽  
Electrolyte Metabolism ◽  
Free Cortisol ◽  
Female Rhesus ◽  
The Central Nervous System

SUMMARY The effect of dexamethasone, given either alone or together with testosterone propionate or androstenedione, was studied in nine female rhesus monkeys (paired with three males) by making quantitative observations on behaviour in the laboratory. Dexamethasone (0·5 mg/kg/day) given to oestrogen-treated ovariectomized female monkeys made them sexually unreceptive, and there was an associated decline in the level of the male's mounting activity. Testosterone propionate (100 or 200 μg/day) reversed completely the effects of dexamethasone on sexual behaviour. Androstenedione (100, 200 or 400 μg/day) had similar, but less marked, effects whereas cortisol (10 mg/day) or progesterone (100, 200 or 500 μg/day) were ineffective. Treating a female with testosterone prevented dexamethasone from reducing sexual receptivity. Parallel determinations of urinary free cortisol showed that the dexamethasone had suppressed the secretory activity of the adrenal cortex. There were no consistent changes, under any treatment, in the females' vaginal epithelia, sexual skins or clitorides, or in their water or electrolyte metabolism. These findings indicate that adrenal androgens regulate sexual receptivity in these female primates, probably by an action on the central nervous system.

scholarly journals Relationships Between 24-Hour Urinary Free Cortisol Concentrations and Metabolic Syndrome in Obese Children

2014 ◽  
Vol 99 (7) ◽  
pp. 2391-2399 ◽  
Author(s):  
Thomas Reinehr ◽  
Alexandra Kulle ◽  
Barbara Wolters ◽  
Caroline Knop ◽  
Nina Lass ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Urinary Free Cortisol ◽  
Obese Children ◽  
Free Cortisol

Paediatric reference range for overnight urinary cortisol corrected for creatinine

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Ole D. Wolthers ◽  
Mark Lomax ◽  
Anne Vibeke Schmedes
Keyword(s):  
Mass Spectrometry ◽  
Reference Range ◽  
Inhaled Corticosteroids ◽  
Prediction Interval ◽  
Geometric Mean ◽  
Urinary Free Cortisol ◽  
Urinary Cortisol ◽  
Cross Sectional ◽  
Systemic Activity ◽  
Free Cortisol

Abstract Objectives Systemic activity of inhaled corticosteroids (ICS) may be assessed via urinary cortisol measurement. Overnight urinary free cortisol corrected for creatinine (OUFCC) has been extensively reported in adult studies. However, a paediatric mass spectrometric (MS) reference range for OUFCC is not established. MS methods for OUFCC avoid cross-reactivity with other steroid hormones and are thus preferable to immunoassays. The aim of the present study was to define an MS OUFCC normative range in children. Methods This was a cross-sectional study of healthy pre-pubertal children from 5 to 11 years. Children collected urine from 10 pm or bedtime, whichever was earlier, until 8 am. Urinary free cortisol was measured via a liquid chromatography tandem mass spectrometry (LC-MS/MS) assay (Acquity UPLC with Xevo TQ-S Mass Spectrometer [Waters]) with in-house reagents. Urinary creatinine was measured using a commercial assay (Roche). Results Complete urine collections were obtained from 72 males and 70 females, mean age (SD) 8.6 (1.9) (range 5.0–11.8) years. The OUFCC 95% prediction interval was 1.7–19.8 nmol/mmol. Geometric mean OUFCC was 5.7; range 1.1–24.8 nmol/mmol. Conclusions The obtained normative LC-MS/MS OUFCC reference data facilitate the use of mass spectrometry OUFCC assays in assessment of systemic activity of endogenous and exogenous corticosteroids in children.

scholarly journals Spontaneous remission of hypercortisolism presumed due to asymptomatic tumor apoplexy in ACTH-producing pituitary macroadenoma

2013 ◽  
Vol 57 (6) ◽  
pp. 486-489 ◽  
Author(s):  
Marcio Carlos Machado ◽  
Patricia Sampaio Gadelha ◽  
Marcello Delano Bronstein ◽  
Maria Candida Barisson Vilares Fragoso
Keyword(s):  
Salivary Cortisol ◽  
Signs And Symptoms ◽  
Spontaneous Remission ◽  
Pituitary Surgery ◽  
Serum Cortisol ◽  
Urinary Free Cortisol ◽  
High Plasma ◽  
Imaging Data ◽  
Cystic Component ◽  
Free Cortisol

Cushing's disease (CD) is usually caused by secretion of ACTH by a pituitary corticotroph microadenoma. Nevertheless, 7%-20% of patients present with ACTH-secreting macroadenomas. Our aim is to report a 36-year-old female patient with CD due to solid-cystic ACTH-macroadenoma followed up during 34 months. The patient presented spontaneous remission due to presumed asymptomatic tumor apoplexy. She showed typical signs and symptoms of Cushing's syndrome (CS). Initial tests were consistent with ACTH-dependent CS: elevated urinary free cortisol, abnormal serum cortisol after low dose dexamethasone suppression test, and elevated midnight salivary cortisol, associated with high plasma ACTH levels. Pituitary magnetic resonance imaging (MRI) showed a sellar mass of 1.2 x 0.8 x 0.8 cm of diameter with supra-sellar extension leading to slight chiasmatic impingement, and showing hyperintensity on T2-weighted imaging, suggesting a cystic component. She had no visual impairment. After two months, while waiting for pituitary surgery, she presented spontaneous resolution of CS. Tests were consistent with remission of hypercortisolism: normal 24-h total urinary cortisol and normal midnight salivary cortisol. Pituitary MRI showed shrinkage of the tumor with disappearance of the chiasmatic compression. She has been free from the disease for 28 months (without hypercortisolism or hypopituitarism). The hormonal and imaging data suggested that silent apoplexy of pituitary tumor led to spontaneous remission of CS. However, recurrence of CS was described in cases following pituitary apoplexy. Therefore, careful long-term follow-up is required.

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