The aim: To study the peculiarities of the clinical manifestations of hypercortisolism in the case of a mass formation in the adrenal gland.
Materials and methods: Childrens Endocrinology of the Republican Specialized Scientific and Practical Medical Center of Endocrinology was hospitalized a boy 5 years old with a diagnosis of extensive tumor of the left adrenal gland.
Results: At the time of the examination, the patient complained with overweight, increased appetite, lethargy, increased blood pressure, and recurrent headaches. Sick for 1.5 years, the age of onset of obesity is 3.5 years. Physical activity is low. Parents are relatives. The onset of the disease they associate with the time of the injury of the arm, after which it became inactive. Complaints of headaches began, blood pressure increased to 130140/8090 mmHg; ultrasound revealed a lesion of the left adrenal gland.The general condition of moderate severity, lethargy, speech is fuzzy. The skin is dry, pale. Red-ruddy face, eyelids and bodies, hyperkeratosis on the elbows, knees, round face, fatigue and poor concentration. Excessive deposition of subcutaneous fat in the abdomen and chest with relatively thin limbs. Fat pads over the clavicles and in the area of the VII cervical vertebra (climacteric hump). According to the results of bone radiography, the child is 33.5 years old, with a chronological age of 4 years and 9 months. According to the biochemical blood test: ACTH-5.5 ng/ml: Cortisol - 153.0 nmol/l: Cortisol - 149.0 nmol/l (12:00 p.m), cortisol 225.7 nmol/l (6:00 p.m). Recommended: tab. Ketokonazole 200 mg 1 time per day before surgery; Tab. ACE inhibitor 5 mg 2.5 mg 2 times a day; Control blood pressure monitoring every 3 hours.
Conclusion: The given example of this clinical case showed the features of the course of ACTH independent Cushings syndrome, corticosteroma. It was recommend consulting an oncologist with the aim of solving the surgical treatment of adrenal tumor surgery. Cushings disease is a rarity that can be difficult to diagnose due to the significant number of varied pathologies indicated by its signs and symptoms.
18 - 21 May 2019
European Society of Endocrinology