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Children with Cushing's syndrome: primary pigmented nodular adrenocortical disease should always be suspected.
MedLine Citation:
PMID:  20924687     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Primary Pigmented Nodular Adrenocortical Disease (PPNAD) is a rare form of bilateral adrenocortical hyperplasia that is inherited in an autosomal dominant manner and leads to ACTH-independent Cushing's syndrome (CS). PPNAD may be isolated or associated with Carney Complex (CNC). For the diagnosis of PPNAD and CNC, in addition to the hormonal and imaging tests, searching for PRKAR1A mutations may be recommended. The aims of the present study are to discuss the clinical and molecular findings of two Brazilian patients with ACTH-independent CS due to PPNAD and to show the diagnostic challenge CS represents in childhood. Description of two patients with CS and the many sequential steps for the diagnosis of PPNAD is provided. Sequencing analysis of all coding exons of PRKAR1A in the blood, frozen adrenal nodules (patients 1 and 2) and testicular tumor (patient 1) is performed. After several clinical and laboratory drawbacks that misled the diagnostic investigation in both patients, the diagnosis of PPNAD was finally established and confirmed through pathology and molecular studies. In patient 1, sequencing of PRKAR1A gene revealed a novel heterozygous 10-bp deletion in exon 3, present in his blood, adrenal gland and testicular tumor. The etiologic diagnosis of endogenous CS in children is a challenge that requires expertise and a multidisciplinary collaboration for its prompt and correct management. Although rare, PPNAD should always be considered among the possible etiologies of CS, due to the high prevalence of this disease in this age group.
Authors:
Renata Marques Gonçalves da Silva; Emília Pinto; Suzan M Goldman; Cássio Andreoni; Teresa C Vieira; Julio Abucham
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pituitary     Volume:  14     ISSN:  1573-7403     ISO Abbreviation:  Pituitary     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9814578     Medline TA:  Pituitary     Country:  United States    
Other Details:
Languages:  eng     Pagination:  61-7     Citation Subset:  IM    
Affiliation:
Neuroendocrine Unit, Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo 910, SP, 04039-002, Brazil, renatamgs@terra.com.br.
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