| Crossing the other side of the algorithm: a challenging case of adrenal Cushing's syndrome. | |
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MedLine Citation:
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PMID: 22674941 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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The diagnosis of endogenous Cushing's syndrome and its aetiology involved documenting the hypercotisolism and then determining whether that hypercortisolism is adrenocorticotropic hormone-dependent (ACTH-dependent) or not. Hence, following the algorithm, an undetected ACTH level points to an adrenal Cushing's while a detectable or elevated ACTH level points to either a pituitary or ectopic Cushing's syndrome. The authors present a case of florid adrenal Cushing's syndrome initially presenting with a normal ACTH level, which led to the investigation for an ACTH-secreting tumour. Adding to the confusion, a MRI done showed an intrasellar focus. Knowledge of how ACTH-dependent (versus ACTH-independent) Cushing's syndrome manifests clinically, supported by results of repeat laboratory tests, led to the true diagnosis. This case illustrates that a detectable ACTH does not rule out an adrenal Cushing's syndrome nor does a positive pituitary imaging confirm Cushing's disease. |
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Authors:
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Imelda Digna Soberano Antonio; Mark Anthony Santiago Sandoval; Frances Lina Lantion-Ang |
Publication Detail:
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Type: Journal Article Date: 2011-12-01 |
Journal Detail:
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Title: BMJ case reports Volume: 2011 ISSN: 1757-790X ISO Abbreviation: BMJ Case Rep Publication Date: 2011 |
Date Detail:
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Created Date: 2012-06-07 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101526291 Medline TA: BMJ Case Rep Country: England |
Other Details:
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Languages: eng Pagination: - Citation Subset: IM |
Affiliation:
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Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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