Endocrine Abstracts

Background: Cushing’s syndrome is the most common cause of endogenous hypercortisolism that results from the excessive exposure to glucocorticoids. Even though this syndrome is represented by a constellation of clinical signs and symptoms, the most common next features are the truncal obesity and the moon facies, making it hard not to be recognized. It is more common in women (F/M=5-8:1) with an avarage age of 20–40 years.

Case Presentation: A 37 years old woman, allergic to fluoroquinolones, was admitted for muscle weakness, hypertension and increased cortisol levels with supressed ACTH and paradoxical response to 1 mg overnight and 2×2 mg dexamethasone supression tests. She was known with endometriosis (immunohistochemically diagnosed) after a partial cystectomy for a bladder tumor, currently receiving treatment with oral contraceptives. Clinical evaluation revealed trucal obesity, moon facies, bufallo bump. Paraclinical evaluation showed high levels of late night salivary cortisol (0.379 ug/dl), urinary free cortisol at the upper limit (100 ug/24 h), the overnight 1 mg dexamethasone test and 2×2 mg dexamethasone test revealed unsupressed levels of cortisol (>1.8 ug/dl), even higher than baseline, 25.22 ug/dl, respectively 21.26 ug/dl. Abdominal CT and MRI with contrast substance indicated a left adrenocortical tumor (2.11 cm/1.90 cm). Hormonal treatment with oral contraceptives, specifically estrogen, is increasing CBP levels leading to a paradoxical response to dexamethasone.

Conclusions: The particularity of the case is based on the endometriosis treatment and allergy treated with glucocorticoids making Cushing’s syndrome harder to diagnose and postponing it.