AN ATYPICAL CASE OF CUSHING SYNDROME

Abstract

A 44-year-old woman was admitted to the hospital because of lumbago and muscular weakness of the lower extremities. X-P of the thoracic and lumbar vertebrae revealed multiple compression fracture. Blood cortisol and urine 17-OHCS levels were as high as 22.7mmg/dl and 11.8mg/day, respectively. ACTH level was in the lower normal limit, 4.4pg/ml. A probable diagnosis of Cushing syndrome due to an adrenal tumor was supposed. With ultrasonography, CT, MRI, and angiography the left adrenal tomor was identified. Under left subcostal laparotomy the mobilization of the pancreatic tail and spleen was performed and the tumor was extirpated. The extirpated tumor was 3.5×2.5×2.5cm in size and 13 g in weight. The section presented canary yellow. Histological findings indicated adrenal adenoma. After the operation mellitus and hypertension improved. Blood cortisol and urine 17-OHCS levels decreased. ACTH increased, because it was released from the negative feedback.