Endocrine Abstracts

Objective: We describe a patient who was dealt as a case of polycystic syndrome for about a decade before it was discovered that she was suffering from Cushing’s syndrome because of anterior pituitary adenoma. Our aim is to highlight the fact that even today PCOS ought to be a diagnosis of exclusion and it is vital to rule out other causes with similar features.

Case report: Our patient is a 45 years old female who was levelled as a case of PCOS 10 years ago, on the basis of presence of menstrual irregularities, primary infertility, acne, hirsuitism (hyperandrogenism), obesity, reduced SHBG and enlarged ovaries with multiple follicles on ultrasound. In her follow up on formal examination she was found having central obesity, buffalo-hump, purple abdominal striae.Her endocrine profile revealed: 24×3 days urinary free cortisol 746 880 966 nmol/l (40–305), LH <0.2 IU/L, FSH 2.9 IU/l, prolactin 248 mU/l (50–700), oestradiol 163 pmol/l, testosterone 2.2 nmol/l (<2.7), SHBG 10 nmol/l (35–110), free androgen index 22.0 (<4.5), ACTH 57 ng/l (<46). Overnight dexamethsone and low dose dexamethasone suppression failed to suppress the morning cortisol. With high dose dexamethsone suppression test the morning cortisol was suppressed to 181 nmol/l (184–623). MRI pituitary showed the presence of right parasagital pituitary adenoma which was resected and histology confirmed the diagnosis of ACTH secreting pituitary adenoma.

Conclusion: PCOS is the commonest endocrinopathy in the reproductive years of any woman where as Cushing’s syndrome is a very rare disorder.But PCOS has many clinical and biochemical features as in our case which could have been explained by Cushing’s syndrome as well. Even today we wonder whether this patient had PCOS to start with and later developed Cushing’s syndrome or she had only Cushing’s syndrome from the beginning or she had both co-existing.