Endocrine Abstracts

Glucocorticoid, known as cortisol, is a steroid hormone essential to the maintenance of homeostasis, and is released in response to stress and low blood glucose concentration. It is converted from cortisone by 11β hydroxysteroid dehydrogenase type 1 (11β HSD1). The liver plays a major organ in metabolism, has numerous functions, mostly consists of hepatocytes, and is a principal target of cortisol. In murine model, it was observed that too much cortisol or overexpres...

Heterophilic antibodies are well-known interferent factors affecting most immunoassays. However, they have been poorly evaluated in routine clinical practice. Definition of Subclinical Cushing’s Syndrome (SCs) has been arbitrary and prevalence has shown significant variations related with the diversity of the diagnostic tests. In most of the guidelines a low or suppressed corticothropin (ACTH) level has been suggested as an important predictor of SCs. Here, we sought to i...

Patients with Cushing disease (CD) are at increased risk of venous thromboembolism (VTE). It was surmised, but not conclusively shown that the risk is related to plasma hypercoagulability secondary to the effect of glucocorticoids. This study aimed at investigating the thrombin-forming potential of patients with CD in the presence of a functioning protein C system by adding its main physiological activator, thrombomodulin. Under these experimental conditions, which mimic close...

Population and methodology: Patients with profound hyponatraemia (serum Na ≤125 mmol/l) admitted 1 November 2014 to 30 April 2015 were identified using hospital admission registry, laboratory’s database and qualitative data from the patients’ electronic records. Discharge summaries and death certificates were reviewed.Objectives: This is a retrospective audit set to asses: i) whether initial investigations of hyponatraemia were performed ...

Primary aldosteronism (PA) describes the most frequent cause of secondary arterial hypertension. Aldosterone itself represents a BP-independent cardiovascular risk factor associated with increased rates of morbidity and mortality. Recently a worsening of lipid metabolism after treatment has been described.Objective: Our aim was to analyse changes in lipid parameters according to treatment outcome in PA patients. Data of 215 consecutive PA patients with u...

The aim of this retrospective study was to compare the long-term evolution of adrenal insufficiency (AI) due to bilateral adrenal surgery (S) or medical cause (M).Seventy AI patients (mean age 41±16 years; 60% female, similar in both groups) were followed during a mean 6-year period (2–16); 38 were AI after bilateral adrenalectomy (60% Cushing), 32 AI of medical origin (62% polyglandular autoimmune syndrome). BMI, blood pressure (BP), fasting b...

Introduction: Purpose of this study is to find a radiological score and to correlate radiological characteristics of adrenal adenomas and functional parameters to predict subclinical glucocorticoid secretion.Methods and materials: This retrospective study included 55 patients with adenomas, investigated through CT with adrenal protocol assessing diameters, HU values of the unenhanced and contrast enhanced phases (enhanced–E, and 15 min delayed enhan...

Introduction: The effect of self-prescribed cross-sex hormone therapy on Male-to-Female (MtF) transgenders do not appear to have been well investigated and can be associated with potential serious longterm complications. The main purpose of this study is to look at the clinical and metabolic profile, and cardiovascular outcomes of MtF transgenders in Zamboanga Peninsula.Methodology: This is a cross-sectional study, done to determine the clinical and meta...

Diurnal salivary and plasma cortisol variations are considered valid expression of circadian cortisol rhythmicity. The aim of this study was to assess the reliability of salivary and plasma cortisol evaluating if glycemia and glycemic oscillations may interfere with their concentration.Methods: Forty-seven type 2 diabetic patients and 31 controls were studied for glycemic profile and diurnal salivary and plasma cortisol variations on two contemporary sam...

Adrenal cortex scintigraphy has been used as early as in the 1970s, however, in recent years, it has been a rarely performed and unappreciated examination. In fact, this examination does not provide a perfect view on morphology of adrenal glands, however it provides an assessment of the examined tumor’s function. The aim of this work is to present our experience with adrenal cortex scintigraphy in assessment of adrenal tumors.We present a series of ...

Aim: The aim of the present study was to evaluate the characteristic features of computerized tomography (CT) and magnetic resonance imaging (MRI) among functioning and non-functioning adrenal lesions.Materials and methods: We retrospectively reviewed the medical records of patients with adrenal mass. CT or MRI findings were available in 89 functioning and 148 non-functioning adrenal lesions (NFAL). Of the patients with functioning adrenal mass, 34 were ...

Introduction: Bilateral macronodular adrenal hyperplasia ACTH-independent (BMAH) represents less than 1% of the causes of Cushing’s syndrome (CS). Studies have shown that mutations in the gene ARMC5 are a common cause of family BMAH and are associated with severe clinical disease and the development of meningiomas.Case report: 64-years-old man presented to our consult due to bilateral macronodular adrenal hyperplasia. He had diabetes mellitus, arter...

Background: Incidentally discovered adrenal tumours have become a common clinical problem. The presence of an adrenal incidentalomas has been associated with an increase incidence of several cardiovascular risk factors. These abnormalities are more frequent in patients with clinical and subclinical hypercortisolism, nevertheless some studies have reported an association between nonfunctioning adrenal incidentalomas (NFAIs) with increased insulin resistance and cardiovascular r...

Introduction: Regardless of improvements in MRI, up to 20% of ACTH-secreting pituitary tumors are only identified at surgical exploration. The objective was to estimate whether there is any difference in blood vessels and the subsequent ability to uptake contrast agent in visualized micro-adenomas as compared to non-visualized on MRI ACTH-secreting pituitary tumors.Materials and methods: Retrospective evaluation of ACTH-positive pituitary tumors from pat...

Background: Congenital adrenal hyperplasia (CAH) is a rare condition that is associated with life long risk of adrenal crisis. Management of CAH demands a fine balance between excess glucocorticoid leading to adverse effects and too little glucocorticoid risking adrenal crises. Frequent occurrence of sick day episodes warrants dose adjustment and education regarding adrenal crisis. In a condition such as CAH it is difficult to collect sufficient data from small cohorts at a si...

Background: The chemokine receptor CXCR4 and its associate receptor CXCR7, that modulates CXCR4 function, have been associated with tumor progression and metastasis in human cancers. In ACC, Ki67 index and ENSAT stage are the most important prognostic parameters.Objective: To assess expression of CXCR4 and CXCR7 in adrenal cancer and correlate results with clinical outcome.Methods: CR expression was assessed by immunohistochemistry...

Background: First-line therapy of ACTH-independent Cushing’s Syndrome (CS) is the resection of the underlying tumor in all cases. After surgical cure of CS, most patients develop transient secondary adrenal insufficiency with a variable time of recovery. Adrenal function testing can identify patients who may require glucocorticoid replacement.Methods: We reviewed 61 patients diagnosed with ACTH-independent CS excluding 6 with adrenocortical carcinom...

Introduction: Cushing’s syndrome (CS) has been related to higher psychopathology. Psychopathology can be related to poor memory performance, and low quality of life. The aim of this study is to establish the relationship between the three parameters and with subjective symptom perception in CS.Methods/design: Thirty six patients in remission of CS and 36 matched controls for age, sex and education years were included in the study. They completed SCL...

Objective: Nonfunctional adrenal masses are a risk indicator of increased cardiometabolic risk. Especially; increased thrombogenic ambient, insulin resistance, hepatosteatosis and abdominal obesity are determined in these patients with nonfunctional adrenal masses. Our purpose was to show the association of adrenal incidentalome and metabolic syndrome in consideration of the studies and to detect the increase in the carotid intima-media thickness which is regarded as the prece...

Introduction: The aim of the study was to asses frequency of the components of metabolic syndrome (MS) according to the criteria of the International Diabetes Federation (IDF) in patients with adrenal incidentaloma (AI) without hormonal activity.Design: The study comprised of patients with AI without hormonal activity, confirmed in CT. The adrenal function was determined by measuring circadian rhythm of cortisol and/or dexametasone suppression test, aldo...

Background: Classical congenital adrenal hyperplasia (CAH) is diagnosed mainly in newborns. While patients with salt wasting form cannot survive without timely diagnosis, those with simple virilizing or nonclassical may be diagnosed even in advanced age.Aim: To present clinical, biochemical, radiological and genetic characteristics of series of CAH patients diagnosed in advanced adulthood.Material and methods: Eight patients (F=5, ...

The aim of this retrospective study was to compare the long-term metabolic evolution of a cohort of patients treated for adrenal insufficiency (AI), and the best biological parameters of a good balance.Seventy patients with AI (mean age 41 years (±16); 60% female) were followed during a median 6-year period (2–16 years): 38 after bilateral adrenalectomy (60% Cushing) and 32 after AI of medical origin (62% polyglandular autoimmune syndrome). BMI...

Introduction: The plasma cortisol response to the ACTH test is known to vary significantly by assays. An automated cortisol immunoassays with increased specificity due to the shift from polyclonal to MABs, and standardized against mass spectrometry was recently introduced, with an expected decrease in cortisol concentrations by 20%. Cut-offs used in clinical practice for patient evaluation will thus have to be adjusted. We aimed to assess the normal cortisol response to ACTH s...

Introduction: Primary aldosteronism (PA) features a higher prevalence of cardiovascular events and renal complications as compared with essential hypertension. The effects of aldosterone excess on ascending aorta have never been investigated in human subjects.Methods: From August 2014 to December 2015, we enrolled forty-seven consecutive PA outpatients who had not undergone surgery of the adrenal mass. Hypercortisolism and pheochromocytoma were excluded....

Introduction: 11β-Hydroxylase deficiency (11β-OHD), caused by CYP11B1 mutations, is characterized by hyporeninemic, hypokalemic hypertension and hyperandrogenism. We studied the mutations of CYP11B1 gene in two patients with classic 11β-OHD.Observations: We present the first case of a 23 year old boy with preliminary diagnosis of 21 β-OHD diagnosed at the age of 10. The patient presented with hypertension and hypokalemia which were ag...

Background: Hypercortisolism is prevalent in type 2 diabetes (T2D), but analytical and functional uncertainties prevail. Measurement of salivary cortisol is considered an expedient screening method for hypercortisolism, but its usefulness in the context of T2D is uncertain.Aim: To compare late night salivary cortisol (LNSC) with the 1 mg overnight dexamethasone suppression test (DST), which was considered ‘reference standard’, in T2D.<p cla...

Introduction: Primary aldosteronism is associated with increased prevalence of cardiometabolic complications. The mechanisms are not fully elucidated, but an association with autonomous cortisol secretion could increase vascular and metabolic risk.Aims: To assess glucocorticoid axis in patients with primary aldosteronism as compared to patients with ACTH-independent Cushing syndrome and control hypertensive patients without gluco or mineralocorticoid exc...

Context: Bilateral adrenalectomy (BADX) has become an important treatment option of Cushing’s syndrome (CS), especially when other treatments have failed. Long-term outcome is not well known.Objective: To evaluate long-term quality of life (QoL) of patients who underwent BADX for CS compared to other therapeutic options.Methods: Fourty five patients with all cause CS were identified: 23 patients had BADX and 22 underwent one o...

Subclinical Cushing’s syndrome (SCs) is used to refer to an adrenal incidentaloma with subtle autonomous cortisol secretion and without typical signs and symptoms of hypercortisolism. Diagnostic criteria are uncertain and arbitrary. In this study we aimed to investigate the power of adenoma size as an independent predictor of SCs.Dokuz Eylul University Adrenal Tumours Study Group database includes 596 patients by January 2016. Briefly, there are 332...

It has been more than 70 years since the first adrenal incidentalomas (AI) were described. Most of these tumors are non-secreting, and are found in 4–7% of adult population. Patients with subclinical hypercortisolism (or autonomous cortisol secretion) (SH) are observed in 1–29% of patients with AIs. Evidence suggests that this condition may be associated with higher prevalence of diabetes, obesity, hypertension and osteoporosis.Between 1999 and...

It has been more than 70 years since the first adrenal incidentalomas (AI) were described. Most of these tumors are non-secreting, and are found in 4–7% of adult population. Patients with subclinical hypercortisolism (or autonomous cortisol secretion) (SH) are observed in 1–29% of patients with AIs. Evidence suggests that this condition may be associated with higher prevalence of diabetes, obesity, hypertension and osteoporosis.Between 1999 and...

Introduction: Adrenal Incidentalomas (AIs) have been associated with an increased risk of metabolic syndrome and dyslipidemia, though evidence regarding the latter is limited and, sometimes conflicting. Lipid abnormalities in patients with AIs have been described to be associated with subclinical hypercortisolism. Our aim was to test if lipid profile in patients with adrenal incidentalomas may predict subclinical Cushing’s Syndrome (sCS).Material an...

Primary Aldosteronism (PA) is the most prevalent cause of secondary hypertension. The aim of this work was to characterize the diagnostic workup, treatment and follow-up of confirmed PA.The adrenal tumour study group of the Portuguese Society of Endocrinology undertook the first retrospective multicentre study of Portuguese PA patients. Data was gathered from nine Portuguese Endocrinology centres (three in the north, one in the centre and five in the sou...

Primary pigmented nodular adrenal disease (PPNAD) is a form of bilateral adrenocortical hyperplasia characterised by small to normal sized adrenal glands containing multiple small cortical pigmented nodules. It may occur independently, but 90% of cases are a manifestation of the Carney complex. Most cases of PPNAD are diagnosed before age 30, and are the result of a germline mutation in PRKAR1A or PDE11A, leading to upregulation of cAMP signalling. It is a cause of ACTH-indepe...

Androgen secreting adrenal tumor is a rare cause of androgen excess in women. There are only few case-reports of androgen producing adenoma in a patient with congenital adrenal hyperplasia.Our patient, 61 year old woman was referred to our department for progressive hirsutism and androgenic alopecia. She did not mention neither excessive facial hair growth nor balding until age of 59 when rapidly progressive balding and overt hirsutism started. She has h...

Background: Menstrual abnormalities (MA) can be the first sign of the disease.Aim: To assess the structure of MA before and after treatment of CD.Material and methods: Twenty-eight women with CD 39 (31.8;43.5) y.o., were investigated initially and 3.5 (2;5.5) years after treatment. Patients were subdivided into three groups: with normal cycles (NC; 26–30 days), oligomenorrhea (31–120 days), amenorrhea (>120 days)....

Introduction: A precisely measured corticoid level is important for decision-making in daily clinical practice. These levels can be influenced in the pre-analytical phase, when the effect of stress, timing, and diet can be important.The aim of this study was to elucidate optimal conditions for blood sampling as well as the choice of analytical methods, which they will be used in measuring of corticoids.Methods: By studying ten wome...

Introduction: Adrenocortical carcinoma (ACC) is a rare endocrine malignancy, with an incidence in the literature of 0.5 to 2 cases per million population per year. The most important prognostic factors are stage of cancer at the time of diagnosis and success of the first surgery. However, advanced age, tumor size, functionality, high Ki-67 index (>10%), necrosis, and high mitotic activity are among poor prognostic factors.Patients and method: Fifteen...

Introduction: Nowadays is believed that primary aldosteronism (PA) is the most frequent cause of secondary hypertension and reaches 10% of whole hypertensive population. The activity of the mineralocorticoid hormone may be change by polymorphism of aldosterone synthase gene (CYP11B2) e.g. in promoter -344T/C region. Aim of this study was to find differences in baseline plasma aldosterone concentration (PAC), plasma renin activity (PRA), aldosterone – renin ratio (ARR) and...

Introduction: Hypoaldosteronism (HA), a cause of hypovolemic hyponatremia (HN) with urinary(U) sodium(Na) loss, is often underdiagnosed. We studied 28 patients with an episode of HA-induced moderate/severe hyponatremia.Methods: Retrospective 2012–2015. In all patients, Nadir(N) serum(S) Na <130 mmol/l (corrected for total proteins and glycemia), low internal yugular venous pressure, low ocular pressure. Addison’s Disease ruled (ACTH, cortis...

Classical form of congenital adrenal hyperplasia (CAH) is associated with the impairment of enzymes involved in process of adrenal steroidogenesis. More than 90% of CAH cases are connected with mutations in the 21-hydroxylase gene CYP21A2 in the HLA class III area on the short arm of chromosome 6p21.3. CAH is characterized by a strong correlation between the genotype and the phenotype. Mutations in the CYP21A2 gene can cause different degrees of loss of 21-hy...

Introduction: Patients referred for adrenal incidentalomas (AI) are increasing. Current guidelines are controversial on diagnosis and length of follow-up.Objectives: Analyze clinical, radiologic and hormonal characteristics of patients with AI. Evaluate the number and usefulness of tests needed for diagnosis, clinical outcome and follow up.Material and methods: Observational, retrospective study in patients with AI in our endocrino...

At present there are no unified diagnostic criteria for subclinical hypercortisolism (SH) in patients with adrenal incidentalomas (AI). Recently it has been proposed that an age and gender specific DHEAS ratio (calculated by dividing DHEAS by the lower limit of the respective reference range) has a significant diagnostic value in detection of SH.The aim was to evaluate the value of DHEAS as a diagnostic tool for SH. Retrospectively we evaluated 140 AI pa...

Introduction: A key feature of a benign adrenal tumor is its hormonal production. It is reflected by serum steroid levels. A tumoral tissue steroid content is not commonly measured.Methods: A steroid metabolome comprising of 65 steroids was measured in four samples from each of two patients using GC-MS in serum before and after 1mg dexamethasone test, in the tumoral tissue and in the adrenal tissue of two female patients with adrenal adenomas. The first ...

Primary adrenal non-Hodgkin lymphoma (PANHL) is extremely rare and constitutes <1% of all NHLs and 3% of extranodal lymphoma. PANHL affects predominantly elderly and males and could arises in the presence of a preexisting autoimmune adrenalitis. Diffuse large lymphomas of B-cell origin (DLBCL) histology is reported in 70% of PANHL cases.The present case is a primary, bilateral DLBCL of adrenal in 75-year-old male patient admitted for abdominal pain, ...

Background: Carney complex (CNC) is a rare multiple neoplasia syndrome, its commonest endocrine manifestation being ACTH-independent Cushing’s syndrome, histologically characterized by primary pigmented nodular adrenocortical disease (PPNAD). There is significant genetic and phenotypic heterogeneity, but deletions at 17q24.2 are rare. We describe the particular characteristics of a patient with a microdeletion in this area.Case report: A 37-year-old...

Background: Primary hyperaldosteronism is one of the major causes of secondary hypertension, with a prevalence rate of about 4–10% in the hypertensive population. Increased secretion of aldosterone usually comes from adrenal adenoma or their hyperplasia (uni or bilateral). Renines plasma levels are reduced as a result of the body’s efforts to curb renine-angiotensin system. It can also be associated with hypokalemi, but not always, more than 60% may not have hypokale...

Introduction: Ipilimumab is a monoclonal antibody against the inhibitory CTLA-4 receptor expressed on T cells. It provokes an upregulation of the immune system. It is known to cause neuroendocrine disorders, such as hypophysitis, hyppothyroidism/thyroiditis and adrenal insufficiency. Althought it is stipulated that thyroid.stimulating hormone (TSH) levels should be evaluated before administration of each dose of ipilimumab as a screen for thyroid diyfunction, there is no reque...

Objective: The aim of the present study was to evaluate cardio metabolic risk factors in patients with non-functional adrenal adenoma.Materials and methods: We studied thirty newly diagnosed adrenal adenoma patients and 30 healthy participants. Fasting glucose, insulin, lipid, hormone profile were evaluated from each patient.Results: The frequency of diabetes mellitus and hypertension were statistically higher in adrenal adenoma gr...

Introduction: Carneys complex is an uncommon cause of ACTH independent cushings syndrome which occurs as a combination of myxomas, spotty pigmentation and endocrine overactivity. Primary pigmented nodular adrenocortical disease (PPNAD) is seen in 25–45% of patients with Carneys complex.Methods: Three patients who were suspected with carneys complex were studied to look if their biochemical radiological and clinical characters could predict postopera...

Introduction: Cushing’s disease (CD) is caused by high adrenocorticotropic hormone (ACTH), usually by a pituitary microadenoma.Material and method: This is a case report investigated in several Romanian centers by performing: morning plasma cortisol, circadian rhythm of plasma cortisol, plasma ACTH, dexamethasone (DXM) suppression tests.Case data: A 57-year female, known with hypertension and osteopenia, was ...

We report a case of acute adrenal crisis in a patient with the antiphospholipid syndrome in a man who was on a therapeutic dose of warfarin. A 64-year-old man presented with vomiting and abdominal discomfort. Temperature was 37.8 °C, pulse 85/min and BP 100/63 mmHg. On examination, there was generalized hyperpigmentation. He had a history of deep venous thrombosis of the lower limbs on two occasions and was on warfarin. He previously diagnosed primary antiphospho...

Introduction: Cushing’s disease (CD) in youth represents a challenge especially related to the therapy and long-term management.Materials and methods: We report the medical history of a child with CD who was followed-up for 7 years. Suggestive endocrine panel and imagery is exposed.Case presentation: A 19-year female was diagnosed at age of 12 with CD. Clinical assessment revealed: weight gain, headache, hyperpigmentation pred...

Introduction: Leiomyomas are benign tumors originating from the smooth muscle cells. They occur more frequently in the uterus and in the gastrointestinal system. Adrenal leiomyomas are rare tumors arising from the smooth muscle of the adrenal vein and its tributaries.Case report: Man, 72-years-old, referred to Endocrinology in the context of an adrenal incidentaloma (20 mm maximum diametre) detected in abdominal-pelvic CT performed for the study of splen...

In ACTH-independent macronodular adrenal hyperplasia (AIMAH) causing Cushing’s syndrome, cortisol secretion is controlled by illegitimate membrane receptors. In the normal adrenal gland, agonists of 5-HT4 receptors have a powerful effect on aldosterone secretion but little effect on cortisol secretion in vitro.The aim of our study is to describe the clinical and hormonal features of patients diagnosed with aberrant serotonin receptor expres...

Objective: To assess clinical characteristics, management and outcome of treatment of Cushing’s syndrome (CS) in King Chulalongkorn Memorial Hospital (KCMH).Method: We performed a retrospective evaluation of 82 patients with CS in KCMH during 2001–2015. Median follow-up time was 36 months [interquartile range 11–35].Results: Of the 82 patients, Cushing’s disease (CD) was diagnosed in 45 patients (55%). Twenty-si...

Introduction: Subclinical hypercortisolism (SH), a condition of biochemical cortisol excess without the classical signs or symptoms of overt hypercortisolism, is thought to be present in the 5–30% of patients with incidentally discovered adrenal mass (adrenal incidentalomas). Some evidence suggest that this condition may lead to long-term consequences of cortisol excess, but indication and potential benefits of adrenalectomy in this state are still in doubt. We analyse a ...

Introduction: Patients with Addison’s disease are burdened by substantial comorbidity and likely require a large package of care. There is a proportion of South African patients who can afford private health-care, comparable to health-care offered in a developed country. We hypothesised that comprehensive package of care costs for Addison’s disease is relatively high.Methods: We identifed 131 patients with Addison’s disease within a privat...

Background: Androgen co-secretion in patients with adrenal Cushing’s syndrome is considered a marker of malignancy. Mixed secretion by benign adrenocortical tumors is rare. We describe a case of a middle aged woman presenting with Cushing’s syndrome and polycythemia.Case report: A 57-year-old lady was referred by the Hematology Service to our Endocrine Clinic for evaluation of an adrenal mass found in an abdominal CT in the course of investigat...

Introduction: Primary hyperaldosteronism is still an underdiagnosed cause of hypertension. The challenge lies however, not only in diagnosing the primary hyperaldosteronism, but also in the distinction between aldosterone-producing adenoma (APA) and idiopathic adrenal hyperplasia (IHA). Establishing the correct diagnosis is after all essential, because surgery is only effective in patients with adrenal adenoma.Case report: We report about a 67-year-old p...

Introduction: Adrenal incidentelomas are new era of the endocrinology. We aimed to see the results of adrenal masses retrospectively.Methods: Patients admitted to the Internal Medicine outpatient clinic for different complaints were retrospectively evaluated. Patients whom abdominal imaging like ultrasonography, magnetic resonance imaging or computed tomography were done and incedentally established adrenal masses were evaluated. Patients with a history ...

Introduction: Primary hyperaldosteronism (HAP) is the main cause of secondary hypertension, with a prevalence estimated between 6 and 20% in resistant hypertension. Clinical suspicion is critical, especially if aldosterone-to-renin ratio (ARR) >25, however the diagnosis is dependent on confirmatory evidence, including aldosterone suppression tests.Methods: Retrospective evaluation of 44 patients with suspected PAH, identified betwee...

Objectives: The present aimed to investigate the circadian pattern of salivary cortisol & sulfatoxy melatonin level in night shift professionals and actual day workers & to find out these changes in the circadian pattern produce by night shift are reversible in due course of time.Methods: 56 Nursing professionals of both gender who perform day and night shifts and 56 actual controls were also recruited in this study. Saliva and urine samples were...

A 49-year-old woman was referred to our hospital for the evaluation of adrenal incidentaloma. She had no past medical history and no family history of notable illness. The patient was 150 cm tall and weighed 60 kg. Her blood pressure was 103/60 mmHg. She had no Cushingoid features. Osteoporosis was absent. Routine laboratory examinations were within the normal ranges including normokalemia. The hormonal examination revealed normal circadian variation in serum cortisol levels (...

Introduction: Hirsutism is a disease in which, women chin, upper lip, chest, abdomen, showing the terminal structure to increase hair growth in the male pattern of distribution as androgen sensitive back and thighs are seen. Neutrophil/lymphocyte ratio (NLR) has been proposed as a simple inflammatory marker of response. Increased value of NLR cardiovascular venture in patients was found to be an indicator of poor prognosis. In our study, we aimed to determine the association b...

Introduction: The estimated annual incidence of Cushing’s disease ranges from 2 to 4 per million. Bilateral macronodular adrenal hyperplasia (BMAH) accounts for <1% of Cushing’s syndrome causes.Case report: We present a case of 58-year-old man who had been suffering typical clinical signs of hypercortisolism for 5 years. He presented hyperglycemia, arterial hypertension, central obesity, thin skin, hemorrhagic diathesis, edemas, weakness an...

Introduction: Polyglandular autoimmune syndrome type II (PGA-II) or Schmidt’s syndrome is a very rare autoimmune disorder and difficult to diagnose because the symptoms of this syndrome depends on the gland which gets involved first. Approximately 14–20 people per million population are affected by polyglandular autoimmune syndrome type II. It is characterised by the obligatory occurrence of autoimmune Addison’s disease in combination with thyroid autoimmune dis...

Introduction: Because of their anti-inflammatory effect, topical corticosteroids are widely used in dermatological diseases. Topical use is typically safe, but serious adverse effects induced by systemic absorption are occasionally reported. We report a patient who developed Cushing’s syndrome due to long-term misuse of topical bethametasone and clobetasol.Case Report: A 24-year-old man presented with rapid weight gain and purple strias in multiple ...

We present a rare case of Non- Hodgkins large B Cell lymphoma presenting as circulatory collapse and acute adrenal insufficiency. A 47 year old woman was referred with a 1 month history of weight loss of 7 kg and vomiting. Shortly after admission her condition deteriorated and she developed acute hypotension, BP was 92/58 mmHg, heart rate 100/mn and required volume resuscitation. Examination revealed a thin woman with generalised hyperpigmentation. Serum sodium was 130 mmol/l,...

Introduction: Generally, symptoms of celiac disease is not accompanied when present together with autoimmune endocrine diseases. In this study, we aimed to investigate the prevalence of silent celiac disease in the APS and autoimmune monoglandular disorders by measuring tissue transglutaminase antibodies (ttgAb).Methods: A total of 103 patients with monaglandular or polyglandular autoimmune endocrine disorders and 32 control subjects were enrolled in the...

Introduction: Hyperaldosteronism usually presents with hypertension and hypokalemia; however, there is recent evidence of a relationship with the parathyroid hormone. There are different theories to try to explain this relationship. Hyperaldosteronism treatment is medical or surgical depending upon etiology. We present three cases in which treatment solely for hyperaldosteronism also cured hyperparathyroidism.Materials and methods: We report three patien...

Introduction: In cases with high-risk metabolic profile the investigations may lead to the discovery of an adrenal tumor (AT). Complex endocrine investigations including computed tomography (CT) scans may point anomalies of the vessels as coronary artery or abdominal aorta.Aim: We report a case associating an AT and severe cardiovascular anomalies which are discovered during endocrine investigations.Case data: A 72-year prior smoke...

Introduction: Cystic lesions of the adrenals are rare and they may develop asymptomatically for a long period of time. Females seem to be more affected and lesion is typically unilateral.Aim: We report a case of young female case incidentally found with a large adrenal pure cystic mass.Case data: A 24-year non-smoking female patient with regular menses since the age of 14 complained of mild abdominal pain for a few days without cor...

Metastatic infiltration of the adrenal glands is a common finding of malignancies, but few case reports showed primary adrenal insufficiency being the presenting manifestation of underlying malignant tumors. Here, we report a case of adrenal insufficiency secondary to metastases from lung adenocarcinoma.A 69-year-old man was admitted to emergency department with weakness, altered mental status, hypotension, fever and weight loss. He had 100 pack-year his...

Background: Adrenal insufficiency (AI) in pregnant women is difficult to manage because of similarity between clinics of decompensation of AI and gestational toxicosis. Objective difficulty is absence of clinical guidelines of management of pregnant patients with AI. We present a clinical case where the management of pregnant patient was not careful, which led to overdose and iatrogenic hypercortisolism.Clinical case: Pregnant woman, 29years old, asked s...

Introduction: X-linked adrenoleukodystrophy (X-ALD) is a rare condition presented mainly in males during childhood and early adulthood. It represents almost 10% of primary adrenal insufficiency (PAI) or Addison’s disease cases.Clinical case: A 67-year-old male was diagnosed at the age of 61 with PAI during testing for mesenteric paniculitis while admitted in Internal Medicine service. He was treated with hydrocortisone and referred to outpatient end...

Introduction: Pheochromocytoma is a rare catecholamine-secreting tumor that arises from the chromaffin tissue of the adrenal medulla. Of the reported cases, only 10% consist in bilateral lesions and the probability of multiple endocrine neoplasia should always be investigated.Case report: Female patient, 19 years old, presented with a clinical history with 2 years of evolution, characterized by episodes of palpitations, headache and abdominal discomfort....

Introduction: Ectopic adrenocorticotropic hormone (ACTH) syndrome is characterized by hypercortisolism due to the hypersecretion of non-pituitary ACTH-secreting tumor leads to the Cushing’s syndrome. Herein, we present a case with Cushing’s syndrome, which is diagnosed ACTH-secreting renal malignant paraganglioma.Case: A 40-year-old woman presented with a 5 month history of newly diagnosed hypertension and diabetes, weakness, hyperpigmentation,...

We report three cases of Cushing’s syndrome (CS) with bilateral adrenal tumors. When bilateral adrenal tumors are encountered, the differential diagnosis is difficult, especially in the functioning bilateral adrenocortical adenoma. Adrenal scintigraphy has become a standard technique to determine the laterality of excessive hormone secretion; however, this examination results in bilateral adrenal activity in the functioning bilateral adrenocortical adenoma. Our three pati...

Introduction: Adrenal myelolipoma is a rare benign tumour composed of mature adipose tissue and hematopoietic tissue. Most lesions are small and asymptomatic, discovered incidentally during autopsy or on imaging studies performed for other reasons. Usually small and asymptomatic, but has been reported to present with symptoms such as abdominal pain resulting from tumour bulk, necrosis or spontaneous retroperitoneal haemorrhage.Case 54-year old woman who ...

Background: Adrenal metastatic melanoma can be found in up to 50% of patients with melanomas. These tumors are not hormone-secreting, and they usually present with locally advanced disease.The case: We report on the presence of a bilateral massive metastatic adrenal melanoma in a 56-year old woman with the initial clinical diagnosis of bilateral adrenal cyst or hemorrhage, and chronic adrenal failure. The patient underwent surgery one month before the ad...

Introduction: A form of ACTH-dependent Cushing syndrome is an ectopic production of ACTH. The aetiology can by benign lesion or a malignant non-pituitary tumor, which is more common. The prevalence of endogenous Cushing syndrome is 1 in 26 000. Ectopic ACTH secretion is responsible for 7–15% of the cases. Principal position of the ACTH-producing tumor is in lungs – a bronchial endocrine tumor and small cell lung cancer. Small peripheral bronchial carcinoids can easil...

Introduction: Cushing’s syndrome (CS) is correlated with prolonged exposure to high levels of glucocorticoid hormones. Although the most common cause is exogenous adrenal tumors incidentally discovered (incidentaloma) may underline CS.Material and method: This is a case presentation of an adult patient. Specific tests for CS have been used: morning plasma cortisol and circadian rhythm, plasma ACTH, testosterone, dexamethasone (DXM) suppression test....

Introduction: Adrenocortical carcinoma (ACC) is a very rare neoplasm with an incidence of about one case per million population. It is an agressive tumor (overall 5-year survival 16–38%) and complete resection is the only curative treatment.Description of methods: We report four cases of ACC. The clinical and biochemical features at diagnosis along with clinical course of the disease are discussed.Results: Four patients (three...

Introduction: Addison’s disease is the commonest cause of primary hypoadrenalism in the western world. Here, we discuss a case of Addison’s with unusual presentation.Case report: A 39-year-old woman with no previous mental health problems was admitted with history of worsening depression over the last 15 months following her divorce. She had low mood and anhedonia in spite of sertraline for more than a year. This was associated with 40 kg weigh...