Endocrine Abstracts

A 55 year old man was seen in an endocrinology clinic for possible diagnosis of Cushing’s syndrome. He described a 6 months history of feeling lethargic and increased facial puffiness and abdominal fat. There Cushingoid signs on examination, namely; moon facies, thin skin and bruises with increased abdominal fat distribution. He was admitted to hospital following symptomatic hyperglycaemia and hypokalaemia (lowest reading 2.7 mmol/l). Initial laboratory results showed raised urinary free cortisol 18091 nmol/24 h, random cortisol 1281 nmol/l which was not suppressed by low or high dose Dexamethasone test along with raised ACTH level. Other test also showed pituitary insufficiency of hypogonadotrophic hypogonadism and hypothyroidism with low TSH levels. Radiographical images did not show evidence of pituitary adenoma but instead there was a nasal space tumour and bilateral bulky adrenal glands. Histology results confirmed the diagnosis of Cushing’s syndrome secondary to Ectopic ACTH from an Olfactory Neuroblastoma. He was medical managed with Metyrapone and Ketoconazole prior to pituitary surgery. Complications of Cushing’s such as diabetes was treated with Metformin and insulin while hypokalaemia with Spironolactone and oral potassium replacement. Following surgical resection of the tumour, all anti-Cushing’s medications were stopped as he was no long producing excess cortisol. However, he continues to be on long-term Testosterone and Thyroid Hormone replacement.