Format

Send to

Choose Destination
See comment in PubMed Commons below
Srp Arh Celok Lek. 2012 Jul-Aug;140(7-8):500-4.

Adrenocorticotrophin-dependent hypercortisolism: imaging versus laboratory diagnosis.

Author information

1
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia. mtancicgajic@yahoo.com

Abstract

INTRODUCTION:

Cushing's syndrome results from inappropriate exposure to excessive glucocorticoids. Untreated, it has significant morbidity and mortality.

CASE OUTLINE:

A 38-year-old woman with a typical appearance of Cushing's syndrome was admitted for further evaluation of hypercortisolism. The serum cortisol level was elevated without diurnal rhythm, without adequate suppression of cortisol after 1 mg dexamethasone suppression test. 24-hour urinary-free cortisol level was elevated. Differential diagnostic testing indicated adrenocorticotrophin (ACTH)-dependent lesion of the pituitary origin. Pituitary abnormalities were not observed during repeated MRI scanning. Inferior petrosal sinus sampling (IPSS) was performed: 1) Baseline ratio ACTH inferior petrosal sinus/peripheral was <2; 2) Corticotropin-releasing hormone (CRH) stimulated ratio ACTH inferior petrosal sinus/peripheral was <3; 3) Baseline intersinus ratio of ACTH was <1.4; 4) Increase in inferior petrosal sinus and peripheral ACTH of more than 50 percent above basal level after CRH; 5) Baseline ratio ACTH vena jugularis interna/peripheral was >1.7. Transsphenoidal exploration and removal of the pituitary tumor was performed inducing iatrogenic hypopituitarism. Postoperative morning serum cortisol level was less than 50 nmol/l on adequate replacement therapy with hydrocortisone, levothyroxine and estro-progestagen.

CONCLUSION:

No single test provides absolute distinction, but the combined results of several tests generally provide a correct diagnosis of Cushing's syndrome.

PMID:
23092037
[Indexed for MEDLINE]
Free full text
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Serbian Medical Society
    Loading ...
    Support Center