Endocrine Abstracts

Endogenous Cushing’s syndrome comes generally with permanent hypercorticism often complicated by diabetes which can be difficult to control. However, the cortisol’s excessive production may be cyclic or intermittent, and, therefore, complications may have a specific course which leads to diagnostic and therapeutic delay.

Observation: We report the case of a 28-year-old woman with no previous medical history who was hospitalized for a Cushing’s syndrome. The clinical picture was marked by severe hypertension requiring triple therapy and poorly-controlled diabetes under intensified insulin therapy (0.7 IU/kg per day). Cushing disease was diagnosed in the presence of high cortisol levels (800 nmol/l), not suppressed after dexamethasone suppression test, and high ACTH levels (106 μg/ml). Surgery was not indicated since the pituitary MRI was normal but the evolution was spontaneously favorable. The clinical signs of Cushing syndrome regressed, blood pressure levels got back to normal and diabetes was cured (we stopped all diabetes medications) for eight years, then Cushing syndrome recurred. The diabetes reappeared requiring once again high doses of insulin (0.9 IU/kg per day). The hormonal assessment was in favor of Cushing disease and the pituitary MRI did not show any abnormalities. Once again, the patient went spontaneously into remission. Blood glucose levels were well-controlled only by metformin. Four years later, Cushing’s syndrome recurred a second time. Diabetes reappeared requiring intensive insulin therapy (0.6 IU/kg per day). Pituitary MRI showed a microadenoma. The patient underwent surgery with complete remission of the Cushing’ syndrome and was cured from her Diabetes.

Conclusion: This case highlights the hyperglycemic hormones role in the genesis of diabetes through its cyclic evolution during a cyclic Cushing.