Cushing’s Disease: Not Always Black and White
نویسندگان
چکیده
Abstract Cushing’s Disease is a well known entity but the difficulty of diagnosis often underappreciated. Given wide spectrum clinical presentation and pitfalls with each diagnostic evaluation, (CD) difficult in practice, even pathological analysis. A 37 year old female history presented for her third transphenoidal resection to our institution. She was diagnosed pituitary microadenoma 16 years ago based on MRI, as she had persistent headaches vision abnormalities. The patient also reported unexplained weight gain, “buffalo hump”, moon facies at time. CD due an abnormal 1 mg overnight dexamethasone suppression test (DST) AM cortisol 3.03 ug/dl (normal <1.8 microgram/dl). oral contraceptive pill (OCP) underwent first transsphenoidal symptom free about 10 years, after which recurrence initial symptoms. another DST while OCP MRI revealed growth adenoma. Patient second surgery benign postoperative course 5 later. workup prior OC pills 8am being 3.36 (<1.8ug/dl), urinary 35.4 mcg/24 hour (4-50 hour). ACTH done separate day 48 pg/ml (6-50 pg/ml) 14.5 ug/dl. Midnight salivary not performed. Interval still positive gain headaches, hence referred surgery. Post surgery, short taper hydrocortisone 32 next day. After discussion pathologist, it determined that pathology suggestive corticotroph adenoma moderate staining patchy nuclear TPIT, although pathologist stated be certain small tissue size. From current literature, this incomplete equivocal biochemical work up OCPs supporting CD. Whether disease, silent adenoma, or non-functioning unclear. This case illustrates multiple challenges disease may encountered. 1.Braun LT et al. Recurrence adult disease: systematic review treatment. Endocrine. 2020;70(2):218-231.
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ژورنال
عنوان ژورنال: Journal of the Endocrine Society
سال: 2021
ISSN: ['2472-1972']
DOI: https://doi.org/10.1210/jendso/bvab048.1184