ECE2015 Eposter Presentations Clinical Cases–Pituitary/Adrenal (95 abstracts)
Cushing's disease in a patient with complicated varicella
Ana Saavedra 1, , Sandra Belo 1, , Maria Manuel Costa 1, , Claudia Nogueira 1, , Paula Freitas 1, , Ana Santos 4 , Lurdes Santos 4 & Davide Carvalho 1,
1Department of Endocrinology Diabetes and Metabolism, Centro Hospitalar S. João, Porto, Portugal; 2Faculty of Medicine, University of Porto, Porto, Portugal; 3Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal; 4Department of Infectious Diseases, Centro Hospitalar de São João, Porto, Portugal.
Introduction: Immunossupression is a possible consequence of hypercortisolism, putting these patients in a state of increased risk of infections.
Case report: Female, 19 years old. In July 2014 she seek for medical care because she became feverish and developed an erythematous rash on her face/trunk with subsequent widespread to the entire body. She was admitted in the ICU with the diagnosis of severe varicella with acute cholestatic hepatitis and confluent necrosis of coagulative type. The patient presented full moon face (more prominent over the last 2 months), truncal obesity starting after menarche (at 10 years old), hirsutism and menstrual irregularities/secondary amenorrhea. Physical examination also showed bruises and reddish purple striae. During hospitalisation she presented hypertension, hyperglycaemia (HbA1c 6.7%) and hypokalaemia. After treatment with antiviral/antibacterial drugs and the resolution of the acute infection, she was evaluated for the suspicion of Cushing’s syndrome, which was confirmed based on: high levels of serum cortisol; high 24 h urine free cortisol (300.1 μg/day); two increased late-night salivary cortisol assays (1.150 μg/dl; 0.961 μg/dl); cortisol after 1-mg overnight dexamethasone suppression test (DST) – 23.0 μg/dl; and cortisol after 2 day low-dose DST – 15.1 μg/dl. As she had high basal ACTH levels (14.7 pg/ml), it was performed a 2 day high-dose DST test (end cortisol – 3.8 μg/dl). Then it was performed a pituitary MRI, which reveals a ‘lesion in the right half of the pituitary gland compatible with a microadenoma’, thus confirming the diagnosis of Cushing’s disease.
Discussion: This clinical case emphasizes the importance of considering hypercortisolism as a condition capable of inducing immunosuppression, which may result in the development of serious infections and, therefore, these severe clinical situations should raise this diagnostic possibility.
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Endocrine Abstracts
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