Multiple Metatarsal Fractures: The First Manifestation of Cushing's Disease—A Case Report

2021 ◽  
Vol 111 (3) ◽  
Author(s):  
Vilim Molnar ◽  
Paulo Zekan ◽  
Tina Dušek ◽  
Alan Ivković
Keyword(s):  
Case Report ◽  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Signs And Symptoms ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Proximal Muscle ◽  
Metatarsal Fractures ◽  
Foot Fracture ◽  
History Of

Cushing's syndrome is an uncommon clinical condition most frequently presenting with central obesity, facial rounding, proximal muscle weakness, and skin thinning. The objective of this case report is to highlight an unusual presentation of Cushing's syndrome. A 35-year-old woman presented to the orthopedic clinic with a 1-year history of foot pain without any history of trauma. Radiography of the foot showed multiple metatarsal fractures. Evaluation for secondary causes of reduced bone strength revealed that the patient had Cushing's disease, although other typical signs and symptoms were not remarkable. It can be concluded that Cushing's syndrome should always be included in the differential diagnosis of foot fracture without any evidence of trauma.

scholarly journals A Case Report of Cushing’s Disease Presenting as Hair Loss

2017 ◽  
Vol 9 (1) ◽  
pp. 45-50 ◽  
Author(s):  
Emily G. Lefkowitz ◽  
Jack P. Cossman ◽  
John B. Fournier
Keyword(s):  
General Population ◽  
Cushing’S Syndrome ◽  
Hair Loss ◽  
Cushing’S Disease ◽  
Signs And Symptoms ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Hormone Production ◽  
Androgen Excess ◽  
Substantial Morbidity

Cushing’s syndrome is a rare endocrine disorder that comprises a large group of signs and symptoms resulting from chronic exposure to excess corticosteroids. Most cases of Cushing’s syndrome are due to increased adrenocorticotropic hormone production from a pituitary adenoma, which is referred to as Cushing’s disease. Most of the signs and symptoms are nonspecific and common in the general population, making a diagnosis often challenging. However, several dermatological manifestations, such as fragile skin, easy bruising, and reddish purple striae, are more discriminatory. Because uncontrolled Cushing’s syndrome of any etiology is associated with substantial morbidity, including increased cardiovascular disease and mortality, it is important to make an early diagnosis. Unfortunately, median delays of 2 years to diagnosis have been reported. We report a case of a woman who had multiple dermatological findings, including facial plethora, easy bruising, violaceous striae, hirsutism, and acne, the latter 2 signs reflecting androgen excess. Of interest, our patient presented with a chief complaint of hair loss, a common complaint in the general population that occurs with a greater frequency in patients with Cushing’s disease and is attributed to androgenetic alopecia, but it is rarely the presenting symptom.

Das Cushing-Syndrom im Spiegel der Haut

2018 ◽  
Vol 6 (1) ◽  
pp. 28-30
Author(s):  
Evgenia Makrantonaki
Keyword(s):  
General Population ◽  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Signs And Symptoms ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Hormone Production ◽  
Androgen Excess ◽  
Common Complaint ◽  
Substantial Morbidity

Cushing's syndrome is a rare endocrine disorder that comprises a large group of signs and symptoms resulting from chronic exposure to excess corticosteroids. Most cases of Cushing's syndrome are due to increased adrenocorticotropic hormone production from a pituitary adenoma, which is referred to as Cushing's disease. Most of the signs and symptoms are nonspecific and common in the general population, making a diagnosis often challenging. However, several dermatological manifestations, such as fragile skin, easy bruising, and reddish purple striae, are more discriminatory. Because uncontrolled Cushing's syndrome of any etiology is associated with substantial morbidity, including increased cardiovascular disease and mortality, it is important to make an early diagnosis. Unfortunately, median delays of 2 years to diagnosis have been reported. We report a case of a woman who had multiple dermatological findings, including facial plethora, easy bruising, violaceous striae, hirsutism, and acne, the latter 2 signs reflecting androgen excess. Of interest, our patient presented with a chief complaint of hair loss, a common complaint in the general population that occurs with a greater frequency in patients with Cushing's disease and is attributed to androgenetic alopecia, but it is rarely the presenting symptom.

ADRENALECTOMY DURING PREGNANCY WITH THE APPEARANCE OF PRE-ECLAMPSIA AT TERM IN A CASE OF CUSHING'S SYNDROME

1960 ◽  
Vol XXXV (II) ◽  
pp. 293-298 ◽  
Author(s):  
Per Bergman ◽  
Hans Ekman ◽  
Britt Håkansson ◽  
Björn Sjögren
Keyword(s):  
Case Report ◽  
Urinary Excretion ◽  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Near Term

ABSTRACT This is a case report of a woman, suffering from Cushing's disease, who conceived before treatment and who underwent successful adrenalectomy during pregnancy. The gestation continued normally until near term when symptoms of pre-eclampsia appeared on unchanged cortisone substitution. The urinary excretion of pregnantriol during the last trimester of pregnancy is described.

scholarly journals Case Report: Consecutive Adrenal Cushing’s Syndrome and Cushing’s Disease in a Patient With Somatic CTNNB1, USP8, and NR3C1 Mutations

2021 ◽  
Vol 12 ◽  
Author(s):  
Mario Detomas ◽  
Barbara Altieri ◽  
Wiebke Schlötelburg ◽  
Silke Appenzeller ◽  
Sven Schlaffer ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Clinical Symptoms ◽  
Adrenal Adenoma ◽  
Signs And Symptoms ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Adrenocortical Adenoma ◽  
Single Individual ◽  
Transsphenoidal Adenomectomy

The occurrence of different subtypes of endogenous Cushing’s syndrome (CS) in single individuals is extremely rare. We here present the case of a female patient who was successfully cured from adrenal CS 4 years before being diagnosed with Cushing’s disease (CD). The patient was diagnosed at the age of 50 with ACTH-independent CS and a left-sided adrenal adenoma, in January 2015. After adrenalectomy and histopathological confirmation of a cortisol-producing adrenocortical adenoma, biochemical hypercortisolism and clinical symptoms significantly improved. However, starting from 2018, the patient again developed signs and symptoms of recurrent CS. Subsequent biochemical and radiological workup suggested the presence of ACTH-dependent CS along with a pituitary microadenoma. The patient underwent successful transsphenoidal adenomectomy, and both postoperative adrenal insufficiency and histopathological workup confirmed the diagnosis of CD. Exome sequencing excluded a causative germline mutation but showed somatic mutations of the β-catenin protein gene (CTNNB1) in the adrenal adenoma, and of both the ubiquitin specific peptidase 8 (USP8) and the glucocorticoid receptor (NR3C1) genes in the pituitary adenoma. In conclusion, our case illustrates that both ACTH-independent and ACTH-dependent CS may develop in a single individual even without evidence for a common genetic background.

BIOSYNTHESIS OF CORTICOIDS AND ANDROGENS IN AN ADENOMA FROM A CUSHING'S SYNDROME PATIENT

1963 ◽  
Vol 42 (2) ◽  
pp. 187-194
Author(s):  
Menek Goldstein ◽  
Marcel Gut ◽  
Ralph I. Dorfman ◽  
Louis J. Soffer ◽  
J. Lester Gabrilove
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Syndrome Patient ◽  
Adrenal Tissue

ABSTRACT Incubation of cholesterol-4-14C and pregnenolone-7-3H with a homogenate of adenomatous adrenal tissue from a patient with Cushing's disease yielded 14C and 3H labelled, cortisol, cortisone, 11-deoxycortisol, deoxycorticosterone, dehydroepiandrosterone, and 11β-hydroxy-androst-4-3,17-dione.

Pitfalls in the diagnosis and management of Cushing's syndrome

2015 ◽  
Vol 38 (2) ◽  
pp. E4 ◽  
Author(s):  
Vivek Bansal ◽  
Nadine El Asmar ◽  
Warren R. Selman ◽  
Baha M. Arafah
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Salivary Cortisol ◽  
Clinical Symptoms ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Biochemical Tests ◽  
Late Night ◽  
Late Night Salivary Cortisol ◽  
Free Cortisol

Despite many recent advances, the management of patients with Cushing's disease continues to be challenging. Cushing's syndrome is a complex metabolic disorder that is a result of excess glucocorticoids. Excluding the exogenous causes, adrenocorticotropic hormone–secreting pituitary adenomas account for nearly 70% of all cases of Cushing's syndrome. The suspicion, diagnosis, and differential diagnosis require a logical systematic approach with attention paid to key details at each investigational step. A diagnosis of endogenous Cushing's syndrome is usually suspected in patients with clinical symptoms and confirmed by using multiple biochemical tests. Each of the biochemical tests used to establish the diagnosis has limitations that need to be considered for proper interpretation. Although some tests determine the total daily urinary excretion of cortisol, many others rely on measurements of serum cortisol at baseline and after stimulation (e.g., after corticotropin-releasing hormone) or suppression (e.g., dexamethasone) with agents that influence the hypothalamic-pituitary-adrenal axis. Other tests (e.g., measurements of late-night salivary cortisol concentration) rely on alterations in the diurnal rhythm of cortisol secretion. Because more than 90% of the cortisol in the circulation is protein bound, any alteration in the binding proteins (transcortin and albumin) will automatically influence the measured level and confound the interpretation of stimulation and suppression data, which are the basis for establishing the diagnosis of Cushing's syndrome. Although measuring late-night salivary cortisol seems to be an excellent initial test for hypercortisolism, it may be confounded by poor sampling methods and contamination. Measurements of 24-hour urinary free-cortisol excretion could be misleading in the presence of some pathological and physiological conditions. Dexamethasone suppression tests can be affected by illnesses that alter the absorption of the drug (e.g., malabsorption, celiac disease) and by the concurrent use of medications that interfere with its metabolism (e.g., inducers and inhibitors of the P450 enzyme system). In this review, the authors aim to review the pitfalls commonly encountered in the workup of patients suspected to have hypercortisolism. The optimal diagnosis and therapy for patients with Cushing's disease require the thorough and close coordination and involvement of all members of the management team.

scholarly journals Adrenocortical Carcinoma in a 3 yrs Girl—A Case Report

1970 ◽  
Vol 22 (1) ◽  
pp. 142-143
Author(s):  
M Nowshad Ali ◽  
S Hoq Miah ◽  
M Meharunnesa ◽  
SM Badruddoza ◽  
Mushtaque Ahmed
Keyword(s):  
Case Report ◽  
Precocious Puberty ◽  
Cushing’S Syndrome ◽  
Adrenocortical Carcinoma ◽  
Pediatric Population ◽  
Signs And Symptoms ◽  
Cushing's Syndrome ◽  
Adrenal Tumour ◽  
Uncommon Tumour

Adrenocortical carcinoma is an uncommon tumour in the pediatric population. Account for only a small fraction of pediatric adrenal tumour. Most tumors in children are functional, and virilization is by far the most common presenting symptom, followed by Cushing's syndrome and precocious puberty. All patients with suspected adrenocortical carcinoma should be carefully evaluated for signs and symptoms of hormonal syndromes. DOI: 10.3329/taj.v22i1.5039 TAJ 2009; 22(1): 142-143

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