Category: Pituitary Disorders/Neuroendocrinology
To present a case of hypercortisolism (CS) without a typical clinical picture.
Methods : The clinical and paraclinical characteristics of the patient are described
Results : Woman, 30 years old, married without children; She started the picture 1 year ago with hair loss and recurrent mycosis at the level of axillary and inguinal regions despite treatment, 6 months before admission note increased appetite, weight gain (15kg) so she received treatment with caloric restriction, orlistat and phentermine without results; she was referred to our hospital where there is evidence of supraclavicular pads and desquamative erythematous lesions at the level of axillary and inguinal regions, no vinous red striae, no ecchymosis, no hirsutism. Analytical: G: 88mg/dl, CT: 256mg/dl, LDL: 199mg/dl, TG: 138mg/dl. IGF1 and GH: normal; Serum cortisol: 28ug/dl (5-25) ACTH: 71.8pg/ml (ND-46), there was evidence of circadian rhythm loss, UFC: 398 and 295 ug/24hours. Dexa2mg test: Serum cortisol: 18.5 and UFC: 154; Dexa8mg test: Serum cortisol: 2.8 and UFC: 26; compatible with Cushing's disease (CD). The pituitary MRI showed microadenoma of 3.5 mm left basal; IPSS was performed with vasopressin that confirmed CD with lateralization to the left. She underwent transsphenoidal adenomectomy that reported an intrasellar tumor of 5x5x5mm whose report was pituitary adenoma with ACTH: 3+ in 60%, and GH: 1+ in 40%; Ki67: 1%. P53 (-). Three months later the patient dropped 10 kg. Receives Hydrocortisone and LT4 with biochemical and normal hormonal control.
The preclinical CS is a new entity, presents mild hypercortisolism, without the typical cushingoid characteristics. Which may be due to early stages of the disease, having been reported cases of mutations of the gene of 11 beta HSD 1. They represent a tenth of the CD and contribute to metabolic changes which revert after treatment.
Conclusion : In the diagnosis of CS a high index of suspicion is always useful.
Jose PAZ-IBARRA– ENDOCRINOLOGIST, HOSPITAL NACIONAL EDGARDO REBAGLIATI - UNIVERSIDAD NACIONAL MAYOR DE SAN MARCOS. LIMA - PERU, Lima, Lima, Peru
Celina Franco– ENDOCRINOLOGY RESIDENT, HOSPITAL REBAGLIATI - LIMA - PERU, Lima, Peru
Cesar Alatrista– ENDOCRINOLOGY RESIDENT, HOSPITAL REBAGLIATI - LIMA - PERU, Lima, Peru
HOSPITAL NACIONAL EDGARDO REBAGLIATI - UNIVERSIDAD NACIONAL MAYOR DE SAN MARCOS. LIMA - PERU
Lima, Lima, Peru
PERUVIAN ENDOCRINOLOGIST, UNIVERSITY TEACHER, ACTIVE MEMBER OF AACE, AREAS OF INTEREST NEUROENDOCRINOLOGY, THYROID, ENDOCRINOLOGY OF REPRODUCTION AND BONE MINERAL METABOLISM
HOSPITAL REBAGLIATI - LIMA - PERU, Lima, Peru
RESIDENT IN ENDOCRINOLOGY