Endocrine Abstracts

Introduction: It is known that about 75% of cases of endogenous Cushing síndorme to a pituitary adenoma (HA) ACTH-producing, 15% to ectopic ACTH and 10% is due to adrenal adenoma.

Case: The patient was 64 years old, derived from Diabetes Mellitus type 2 of about 16 years of history with an unwieldy+hypertension diagnosed in 2007 with no physical signs compatible with hypercortisolism and incidentally detected a left adrenal adenoma 2 cm. Hormonal blood studied found: Nugent test:20.9. Morning Cortisol: 11.2; morning ACTH.: 21.7; evening Cortisol.: 11.3; evening ACTH.: 14.7; Free cortisol 24 h urine(UCF): 713 (36–137). After supression 2 mg of dexametasona four 6 h: UCF 24H: 483 and morning cortisol 10.3. Finally, after 8 mg. DXM at 23 h: Morning Cortisol: 23. In MRI pituitary microadenoma left 3 mm. so petrosal sinuses catheterization there is no clear lateralization and showed anomalous venous drainage. To rule ectopic Cushing, scan were performed with somatostatin receptors (negative), In CT existence of a millimeter thoracic nodule in the LSI without observing other injuries suprarrrenal adenoma and left unchanged in size.

After many studies, we decided to repeat like pituitary MRI, so after pharmacological control: Ketoconazole 200 mg (2-1-1), metopirone 250 mg (3-2-2) intervention was decided transsphenoidal with disappearance of injury in MRI.

Discussion: Petrosal sinus catheterization is the most effective means of diagnosis of pituitary Cushing vs ectopic. But it should not be considered definitive for the diagnosis because i like in this case had an abnormal venous drainage not help the diagnosis. Moreover, as in this case the size of AH <1 cm detection depends interobserver variability. Therefore, as in this case we must evaluate the results together to reach the final diagnosis.