Endocrine Abstracts

Cushing’s is a challenging disease to diagnose. The diagnosis is often delayed because Cushing’s is frequently masked by its overlap with more common medical problems such as diabetes, high blood pressure, obesity and polycystic ovary syndrome. Cushing’s may be more common than previously thought. The patient is a 15-year-old girl who developed symptoms of hyperandrogenia about 3 years prior to her visit to the Endocrine medical research Center, Uzbekistan. The problems with the girl began with the onset of the mensis, when she was 10 years old. She had experienced rapid weight gain from 40 to 55 kg, however had grown only by 7 cm in height in 2 years, while mensis was regular. An initial endocrine evaluation revealed some acne on her face; neither moon face nor buffalo hump was noted. Her growth rate was 1.1 cm/year during this period. Then, about 6 months later, her main complaints were of weight gain, seborrhea, buffalo hump, ‘dirty’ and greasy skin, acne, menstrual dysfunction, in spite of this thickened skin and absence of stretch marks gave false appearance of disease. Laboratory testing showed cortisol and ACTH values were normal, testosterone level was slightly high and LH/FSH ratio was changed. A pelvic ultrasound confirmed polycystic ovaries. The clinical and laboratory tests were consistent with PCOS. Therapy with life style changes (weight reduction), metformin, oral contraceptives (OC) was started. Without OC, the menstrual cycle was absent. When she was 16, she started suffering from hypertension, hump was very clear, single striae was there. Cortisol and ACTH levels were slightly high, but electrolytes were normal. MRI investigation showed hyperplasia of pituitary gland. PJD (Pubertal Juvenile Dyspituitarism) was suspected by doctor. After one year, she subsequently developed back pain and was found an osteopenia. MRI showed- corticotropinoma of pituitary gland. ACTH, cortisol values were high. The patient was scheduled for surgery and underwent transsphenoidal resection of her pituitary microadenoma. Patient was successfully treated with surgery and achieved remission from her Cushing’s disease. After surgery, she lost 8 kg, menstrual cycles were regular, concentrations of cortisol, ACTH, testosterone and electrolytes were normal. She will be monitored for recurrence the rest of her life. In conclusion, pituitary corticotropinoma in early stages of life doesn’t have specific symptoms. In our case, it masked by PCOS, lately PJD. Only after 6 years we were able to diagnose Cushing’s Syndrome.