Endocrine Abstracts

We report a case of Cushing’s disease associated to nephrotic syndrome. A 21-year old female was admitted to Cittadella-Hospital due to recent occurrence of weight gain, acne, hirsutism, amenorrhea and mild hypertension. Physical examination revealed truncal obesity, moon face, buffalo hump and a bilateral ankle edema. Suspected hypercortisolism was confirmed by elevated 24 h urinary cortisol (385 μg/24 h, normal range 32–250 μg/24 h) and failure to suppress plasma cortisol after 1 mg DST (42 μg/dl.). Plasma ACTH was high on two consecutive days (69.5–62.3 pg/ml, normal range 10–46 pg/ml) supporting the diagnosis of ACTH-dependent Cushing’s syndrome. Brain MRI revealed in fact a tumor mass of 5 mm in the pituitary gland, and transsphenoidal pituitary adenomectomy was programmed. During pre-surgery hospitalization, biochemical tests revealed hypoalbuminemia (2 g/dl), hypercholesterolemia (345 mg/dl) and severe albuminuria (21.7 g/24 h) in the presence of normal creatinine levels (1.08 mg/dl), all consistent with a nephrotic syndrome. After surgery, ACTH and cortisol levels rapidly normalized and clinical features of Cushing’s disease improved. Low serum albumin (2.1 g/dl) and proteinuria (6.89 g/24 h) persisted. Renal biopsy was then performed and microscopic examination showed a marked mesangial expansion, indicating a rather advanced stage of glomerulonephritis. Combined therapy with albumin, furosemide and exogenous glucocorticoids was of benefit on proteinuria but induced recurrence of Cushing’s phenotype. Pituitary gland at MRI control was normal. The present case represents a rare association between endogenous hypercortisolism due to an ACTH-secreting pituitary adenoma and a nephrotic syndrome. We suggest that the renal damage was hidden by Cushing’s disease and that normalization of cortisol levels due to pituitary adenomectomy triggered the full appearance of kidney disease.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.