Endocrine Abstracts

A 76-year obese women with diabetes mellitus t II, hypertension and urolithiasis was referred to our clinic for reason of high cortisol levels, which were detected in regional hospital, two days after cystoscopy and catheterization of right ureter. Cortisolemia was 35 μg% at 8.00 and 37 μg % at 22.00. Short dexamethasone test didn’t cause cortisol suppression (cortisolemia after 1 mg DXM was 27 μg %). After two days of dexamethasone (4×2 mg) blood cortisol level was 17 μg %. Blood samples were taken during the antibiotic therapy.

In our clinic we performed a CT scans of kidneys and adrenal glands. It revealed little tumour of left adrenal gland (size 14 mm and low density). Then, Cushing syndrome of adrenal origin was suspected.

Eight hours after the examination, patient’s temperature ran up to 39  °C and symptoms of urosepsis occurred. Cortisol level during this event (at the evening) was >50 μg %, DHEAS was low (348 ng/ml). Surprisingly, ACTH level was very high (323 pg/ml).

After ten days of the treatment with ciprofloxacin, when patient’s general condition became good, endocrinological tests were repeated. Cortisol levels were normal, with maintained circadian rhythm (18.7–8.6 μg %), ACTH levels were 16 (8⁰⁰) and 5 (22⁰⁰) pg/ml. Dexamethasone caused proper suppression of serum cortisol (1,8 μg % after 1 mg), and MRI revealed little hypophysis, without adenoma. The tests were repeated after three months, results were also normal.

In conclusion: Observed disorders came out of normal physiological reaction of hypothalamo-pituitary-adrenal axis to stress – in described case to serious infection. Little adrenal adenoma might contribute to very brisk cortisol response to high, ‘stressed’ ACTH levels.