Cushings syndrome is a collection of signs and symptoms due to prolonged exposure to cortisol. It can be difficult to diagnose, particularly endogenous Cushings syndrome, because other conditions share the same signs and symptoms. Diagnosing Cushings syndrome can be a long and extensive process, its treatment may be also an important challenge. We present the case of a 49-year-old man, with a history of asthma and pulmonary cribriform adenocarcinoma (radio and chemo-treated), referred to gastroenterology department with liver cirrhosis observation. Clinically he presented increase in abdomen volume, purple stretch marks, proximal myopathy, physical and mental asthenia, dorsal spine pain; in association with the pulmonary neoplastic pathology, was rised the suspicion of a paraneoplastic Cushing syndrome. The hormonal panel indicated supressed ACTH <5 pg/ml, cortisol after 1 mg dexamethasone suppression test >24.1 ug/dl, rised free urinary cortisol (450 ug/24H) and the thoraco-abdominal CT revealed the presence of an right adrenal mass (27/31/3605 mm), with an washout suggestive for adenoma. Investigations also revealed an hypercoagulability status, modified basal glucose and severe osteoporosis with impeared spinal settlements. Because surgical treatment cannot be performed (obstructive ventilatory dysfunction associated with important heart failure and long evolution asthma), symptomatic medication, antiresorbtive treatment and steroidogenesis inhibitors, represented the only therapy. The particulary of the case consist in pulmonary cribriform adenocarcinoma in association with adrenal mass, differential diagnosis making it hard between paraneoplastic Cushing syndrome, paraneoplastic ascites and adrenal adenoma.
18 May 2019 - 21 May 2019