Endocrine Abstracts

Introduction: Phaeochromocytoma and Cushing syndrome are two uncommon endocrine conditions. The association of these two conditions is very rare and not well elucidated. We report an association of a phaeochromocytoma with an ACTH-dependant Cushing syndrome.

Case report: A 32-years-old female patient was admitted in the endocrine department for paroxysmal hypertension diagnosed in the immediate post partum period. She reported sweating and palpitation crises occurring with hypertensive peaks. Her blood pressure on treatment (calcic inhibitor and central antihypertensive) was 95/70. Clinical examination didn’t reveal any evidence for Cushing syndrome. Laboratory findings showed hypokalaemia at 3.8 meq/l with a hyperkaliuresis. CT-scan revealed a 34×34 mm homogenous right adrenal mass. Urinary metanephrines were very high confirming phaeochromocytoma. Cortisol after low dose dexamethasone suppressing test (LDDST) was 60 nmol/l confirming the diagnosis of Cushing syndrome. ACTH was 39 ng/l and cortisol was suppressed by high dose dexamethasone test. Pituitary MRI was normal. The patient had an endoscopic adrenalectomy. Histology concluded to phaeochromocytoma. After surgery, hypertension and hypokaliaemia disappeared. Urinary metanephrines became normal and cortisol was suppressed by LDDST.

Conclusion: This is a rare case of phaeochromocytoma with a paraneoplasic ACTH secretion causing a subclinical Cushing syndrome.