Endocrine Abstracts

Forty-three years old lady with background of hypertension was seen in the GP surgery with hirsutism noticed over years. She was referred to the gynaecologist for further work up who in turn discharged her back suggesting possibility of PCOS in view of her biochemical and clinical findings but with no radiological evidence of ovarian cysts.

Her PMHx was significant for mild asthma though rarely requiring inhaled steroids.

Previously she was investigated for the cause of hypertension with all of her biochemical results reported as negative. She remained on triple agents for blood pressure control.

Her symptoms and signs gradually progressed, prompting her to seek medical attention form the local GP surgery from time to time (2011–2016).

On her ultimate referral, to the endocrinology clinic, she was investigated for the cause of hirsutism and male pattern baldness along with her coexisting hypertension.

Investigations and treatment: Overnight dexamethasone suppression test (DST): 9 AM Cortisol: 533 Post Dose: 581, Low dose DST: Plasma ACTH:< 0.1 Baseline Cortisol: 583 Post 48 h: 590, plasma aldosterone: renin: normal, urine catecholamine: normal LH FSH TFTs normal, MRI ABDO: solid mass measuring about 2.6 cm in diameter arising from the left adrenal. A diagnosis of adrenal Cushings was made and a diagnosis of adrenal Cushings was made and she was commenced on Metyrapone until Laparoscopic left adrenalectomy. Post procedure she was started on cortisol replacement and no longer required three antihypertensive drugs.

Conclusion and points for discussion: One of the rear but important cause of Cushing syndrome (endogenous) is adrenal tumour which is ACTH independent in nature with intact HPA where the Cortisol excess is solely of adrenal origin. This case highlights the importance of appropriate investigations for the patients with hirsutism as well as hypertension>The diagnostic dilemma lingering on for years in this young with an obvious endocrine condition which remained uncovered for years putting her at great risk of morbidity and mortality associated with this condition.