A 36 year old man presented with a six month history of palpitations. An ECG in a different hospital had showed a sinus tachycardia. An echocardiogram had also been performed and reported as normal. There were no apparent clinical features to suggest Cushings Syndrome (BMI 26 kg/m2). Resting pulse was 86/min. BP was 140/90. Examination was otherwise unremarkable.
Baseline biochemical and haematological investigations including TFT, FBC were normal. Twenty-four hour ECG confirmed sinus tachycardia throughout with a mean heart rate of 90 BPM (range 60167). Urine VMA was normal at 5.4 mg/24 hours (06.3). Adrenal CT (while awaiting urine catecholamines) was requested and showed a left adrenal mass measuring 14×11×14 cm. MIBG scan was negative.
Serum cortisol was high and failed to suppress with Dexamethasone. Urine HIAA was normal. The patient underwent laparascopic adrenalectomy. Histology of the adrenal mass was reported as adrenocortical carcinoma. His tachycardia resolved.
This case illustrates an unusual presentation with atypical symptoms. Symptoms of stress due to cortisol excess may be presenting features of Cushing syndrome. This diagnosis should be considered in such patients.
01 - 05 Apr 2006
European Society of Endocrinology