Endocrine Abstracts

Introduction: Cushing’s syndrome describes symptoms associated with prolonged exposure to inappropriately high levels of cortisol. It may be increased as a result of high ACTH production in the pituitary gland or from tumours outside pituitary–adrenal system.

Case report: Patient 34 years old was hospitalised with complaints of muscle weakness, shooting-pain in thoracic, lumbar spine, decreased height, amenorrhea, arterial hypertension and change in appearance at September 2009. The first symptom of disease was elevated blood pressure at 2007. Patient marked appearance of red striae at July 2009. Next month, compression fracture of five to nine thoracic vertebras was founded based on MRI. At the same time, increased level of ACTH was revealed, but his fact was disregarded. Thus, it was passed 2 years from first complaints to supposition of Cushing’s syndrome. In the hospital, as a result based on positive suppression test with dexamethasone 1 mg and positive test with desmopressin, ACTH–ectopic syndrome was diagnosed. In the same time, tumour of central mediastinum was revealed. Patient was operated, but histology found out, that this tumour consisted of adipose tissue. Patient was repeatedly hospitalized with same complaints at October 2010. New attempts of revealing ACTH-productive tumour was become unsuccessful again. Thus, left-side laparoscopic adrenalectomy was performed 6th October 2010. Right-side laparoscopic adrenalectomy was done in 2 weeks. Hormonal replacement therapy (prednisolone 30 mg/daily) was prescribed after surgery. But, acute adrenal insufficiency was developed in 3 weeks, and patient died. Clinical diagnosis was confirmed on autopsy. But, ACTH-productive tumour wasn’t revealed.

Conclusion: This clinical case demonstrates problems in ACTH–ectopic syndrome diagnostics. it was passed 2 years since first complaints until supposition of Cushing’s syndrome, despite of typical clinical signs in this patient. Also, there is no common guideline of ACTH–ectopic syndrome. Lingering search of tumour delayed decision making about two-sided laparoscopic adrenalectomy.