Document Detail

Crossing the other side of the algorithm: a challenging case of adrenal Cushing's syndrome.
MedLine Citation:
PMID:  22674941     Owner:  NLM     Status:  MEDLINE    
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.
Imelda Digna Soberano Antonio; Mark Anthony Santiago Sandoval; Frances Lina Lantion-Ang
Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-12-01
Journal Detail:
Title:  BMJ case reports     Volume:  2011     ISSN:  1757-790X     ISO Abbreviation:  BMJ Case Rep     Publication Date:  2011  
Date Detail:
Created Date:  2012-06-07     Completed Date:  2013-11-05     Revised Date:  2013-12-05    
Medline Journal Info:
Nlm Unique ID:  101526291     Medline TA:  BMJ Case Rep     Country:  England    
Other Details:
Languages:  eng     Pagination:  -     Citation Subset:  IM    
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MeSH Terms
Adenoma / complications,  radiography*,  surgery
Adrenal Gland Neoplasms / complications,  radiography*,  surgery
Adrenocorticotropic Hormone / blood*
Cushing Syndrome / blood,  diagnosis,  etiology*
Diagnosis, Differential
Magnetic Resonance Imaging
Pituitary Neoplasms / secretion*
Young Adult
Reg. No./Substance:
9002-60-2/Adrenocorticotropic Hormone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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