Pheochromocytoma combined with unusual form of Cushing's syndrome and pituitary microadenoma

Background: Cushing’s syndrome is condition caused by excessive glucocorticoid with insomnia as one of its neuropsychiatric manifestation. Cushing’s syndrome may be caused by excessive adrenocorticotropin hormone (ACTH-dependent), for example from ACTH producing pituitary tumors, or by overproduction of cortisol by adrenocortical tumors. In this report, we presented a case with Cushing’s syndrome manifesting as chronic insomnia with adrenal cortical adenoma and pituitary microadenoma.Case presentation: A 30-year-old woman was consulted from the Neurologic Department to the Internal Medicine Department with the chief complaint of insomnia and worsening headache since 6 months prior to the admission. She had undergone head MRI and abdominal CT scan previously and was found to have both pituitary microadenoma and left adrenal mass. From the physical examination she had clinical signs of Cushing’s syndrome like Cushingoid face and purplish striae on her stomach. Midnight cortisol serum examination was done initially and showed high level of cortisol. High dose dexamethasone suppression test or DST (8 mg overnight) was later performed to help determine the main cause of Cushing’s syndrome. The result failed to reach 50% suppression of cortisol serum, suggestive that the Cushing’s syndrome was not ACTH-dependent from the pituitary but potentially from overproduction of cortisol by the left adrenal mass. Therefore, left adrenalectomy was performed and the histopathological study supported the diagnosis of adrenal cortical adenoma.Conclusion: Chronic insomnia is a very important symptoms of Cushing’s syndrome that should not be neglected. The patient had both microadenoma pituitary and left adrenal mass thus high dose DST test (8 mg overnight) needed to be performed to differentiate the source of Cushing’s syndrome. The result showed only little suppression therefore the pituitary microadenoma was not the source of Cushing’s syndrome and more suggestive from the adrenal etiology.

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Incidentally detected sellar spine in a patient with Cushing’s syndrome: a case report

Journal of International Medical Research ◽

10.1177/0300060520940159 ◽

2020 ◽

Vol 48 (7) ◽

pp. 030006052094015

Author(s):

Hyo-jae Lee ◽

Yun Young Lee ◽

Byung Hyun Baek ◽

Woong Yoon ◽

Seul Kee Kim

Keyword(s):

Cushing’S Syndrome ◽

Cushing's Syndrome ◽

Inferior Petrosal Sinus ◽

Resonance Imaging ◽

Operative Field ◽

Anatomical Variant ◽

Inferior Petrosal Sinus Sampling ◽

Pituitary Microadenoma ◽

Bony Spur ◽

Exploratory Surgery

Sellar spine, a bony spur extending anteriorly from the dorsum sellae, is a very rare anatomical variant. Several hypotheses regarding its etiology have been proposed, including the strongly supported theory of a cephalic ossified notochordal remnant. Sellar spine is usually detected incidentally in patients who have no definite symptoms, but several cases have reportedly accompanied endocrinopathies such as precocious puberty, hypopituitarism, or galactorrhea/oligomenorrhea. However, no published reports have described sellar spine in a patient with Cushing’s syndrome. We herein report a case of sellar spine detected during the evaluation of Cushing’s disease in a 29-year-old woman who underwent inferior petrosal sinus sampling, computed tomography, magnetic resonance imaging, and exploratory surgery. There was no evidence of a pituitary microadenoma, but a sellar spine was present in the operative field. Thus, the sellar spine might have caused Cushing’s syndrome in this case, although the exact mechanism is unknown.

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Selecting The Best Treatment Option For A Dog With Cushing’S Syndrome

Acta veterinaria ◽

10.1515/acve-2015-0001 ◽

2015 ◽

Vol 65 (1) ◽

pp. 1-19

Author(s):

GALAC Sara

Keyword(s):

Cushing’S Syndrome ◽

Vascular Invasion ◽

Clinical Signs ◽

Specific Treatment ◽

Pituitary Tumors ◽

Cushing's Syndrome ◽

Pituitary Microadenoma ◽

Recommended Treatment ◽

Good Clinical Condition ◽

Long Life

Abstract Spontaneous hypercortisolism or Cushing's syndrome is a common endocrinopathy in dogs. Pituitary-dependent and adrenal-dependent hypercortisolism each require specific treatment and diagnostic imaging is very helpful in choosing the treatment that is appropriate. The aims and expectations of the treatment need to be established beforehand and discussed with the owner to avoid unexpected disappointments. The clinical signs of pituitary-dependent hypercortisolism caused by a pituitary microadenoma can be managed with the adrenocorticostatic drug trilostane, but the drug will not affect the pituitary tumor. Hypophysectomy is therefore preferred in those dogs that have an enlarged pituitary but are in good clinical condition and have a long life-expectancy. Inoperable pituitary tumors can be treated by radiotherapy. The best treatment in dogs with cortisol-secreting adrenocortical tumors is adrenalectomy. If surgery is not possible, because of vascular invasion or metastatic spread, mitotane is recommended. Treatment with trilostane can be considered but is only palliative: it does not affect the adrenocortical tumor.

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Phaeochromocytoma comb?ned with subclinical Cushing's syndrome and pituitary microadenoma

Clinical & Investigative Medicine ◽

10.25011/cim.v31i3.3475 ◽

2008 ◽

Vol 31 (3) ◽

pp. 176 ◽

Cited By ~ 5

Author(s):

Guzin Fidan Yaylali ◽

Fulya Akin ◽

Mehmet Bastemir ◽

Yalin Tolga Yaylali ◽

Akin Ozden

Keyword(s):

Adrenal Gland ◽

Cushing’S Syndrome ◽

Adrenal Mass ◽

Sella Turcica ◽

Cushing's Syndrome ◽

Urinary Catecholamines ◽

Pituitary Microadenoma ◽

Free Cortisol ◽

Cortisol Levels ◽

The Right

Objectives: Phaeochromocytoma (PHEO) occasionally associates with pathological lesions of the adrenal cortex. The coexistence of PHEO and pre-clinical Cushing's syndrome (PCS) of the same adrenal gland has rarely been reported. We report a case of PHEO and PCS originating from the same adrenal gland and discuss the peculiar diagnostic aspects of this entity. Clinical Presentation: A 64 yr old man was hospitalized to evaluate the right adrenal mass which was discovered incidentally by ultrasonography. He had a history of type 2 diabetes mellitus and hyperlipidemia. Blood pressure measurements were all normal during his hospital stay. Laboratory examination showed: urinary catecholamines were markedly increased. HbA1C of 14.3 %, midnight cortisol of 11(?g/dL), cortisol was not suppressed after the overnight 1 mg oral dexamethasone suppression test (DST): 3.42(?g/dL), 24 hr free cortisol in the urine : 213 µg/day (10-100), cortisol levels were suppressed more than 50% with 8 mg of dexamethasone. CT scan of the adrenal glands showed a 6 cm well encapsulated right adrenal mass together with a clearly normal left adrenal gland. MRI investigation of the sella turcica revealed a pituitary microadenoma on the right side of the adenohypophysis He was treated with ? and subsequent ? blockers after the diagnosis of PHEO and PCS was made. Right adrenalectomy was performed. The pathology showed typical PHEO with adrenocortical hyperplasia. VMA, metanefrin and free cortisol levels were normalized one month after surgery. Conclusion: The present report is a rare case of PHEO combined with PCS in the same adrenal gland.

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Continuous Etomidate for the Management of Cushing’s Syndrome Complicated by Pulmonary Nocardiosis

Journal of Pharmacy Practice ◽

10.1177/08971900211017487 ◽

2021 ◽

pp. 089719002110174

Author(s):

William Blake Hays ◽

Quinn Czosnowski

Keyword(s):

Cushing’S Syndrome ◽

Opportunistic Infections ◽

Serum Cortisol ◽

Cushing's Syndrome ◽

Level Of Care ◽

Pituitary Microadenoma ◽

Oral Medications ◽

Advanced Airway ◽

Slow Onset ◽

Serum Acth

Severe Cushing’s syndrome is associated with significant complications including opportunistic infections. In the setting of infection, urgent reduction of circulating cortisol is warranted and commonly used oral medications have a slow onset of effect. Here we describe a 29-years old female who presented to an outside hospital with symptoms of untreated Cushing’s syndrome on ketoconazole. Following identification of a pulmonary Nocardia spp infection, she was transferred for a higher level of care. Her initial serum ACTH and cortisol levels after transfer were 106pg/mL and 53.7mCg/dL respectively. Given the severity of her nocardiosis and lack of response to ketoconazole, the patient was placed in the ICU and started on a continuous etomidate infusion. Her serum cortisol rapidly decreased to 5.7mCg/dL. She was transitioned to metyarapone and the etomidate infusion was weaned to off. The etomidate infusion was well tolerated without adverse effects or need for an advanced airway. Following discontinuation of etomidate, she was found to have a pituitary microadenoma that was resected. The patient was discharged from the hospital on antibiotics for the management of her Nocardia spp infection. In patients with severe Cushing’s syndrome, continuous etomidate may be safe and effective for patients who are unresponsive to other therapies.

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