A case of cushing syndrome of undetermined cause managed medically with cabergoline

Muneer Ahmad,Charles Naveenan Antonypillai

doi:10.4038/sljm.v27i2.95

Muneer Ahmad, Charles Naveenan Antonypillai

Open Access

https://doi.org/10.4038/sljm.v27i2.95

Copy DOI

Abstract

We report a 77 year old lady with hypertension and hypokalaemic metabolic alkalosis who was found to have ACTH dependant Cushing Syndrome (CS). Cortisol level was not suppressed during low dose as well as high dose dexamethazone suppression test (HDDST). Her pituitary MRI was normal and inferior petrosal sinus sampling was consistent with ectopic ACTH secretion. CECT of the abdomen and chest was normal. She was started on medical treatment with a plan of re-imaging during the follow-up. As she couldn’t tolerate ketoconazole and since our options were limited, she was started on Cabergoline to which she has shown a good response until the time of this report. Cabergoline has been reported to show varying efficacy according to the available literature. This report highlights the efficacy of cabergoline in this selected case of CS.

Highlights

Cushing syndrome (CS) is a constellation of signs and symptoms resulting from supra-physiological cortisol levels
Contrast enhanced CT of the chest and abdomen was negative for culprit lesions
The patient is being closely followed up for dose adequacy, drug side effects and any new evidence of the primary lesion. In this patient with ACTH dependant CS, pituitary MRI, high dose dexamethazone suppression test (HDDST) and Inferior petrosal sinus sampling (IPSS) were concordant in suggesting an ectopic ACTH secretion

Summary

Introduction

Cushing syndrome (CS) is a constellation of signs and symptoms resulting from supra-physiological cortisol levels. A 77-year-old female patient was investigated in a medical ward for nonspecific symptoms such as body aches and malaise. Biochemical investigations (table 1) revealed spontaneous hypokalaemia with non-suppressed ODST, LDDST and HDDST and inappropriately normal ACTH levels confirming ACTH dependant CS. Brain MRI with dynamic studies did not show any pituitary lesions.

Results

Conclusion