SFEEU2023 Society for Endocrinology Clinical Update 2023 Additional Cases (69 abstracts)
Severe Cushing’s Syndrome in a 24 year old female
Gordon Sloan 1,2 , Ruth Macinerney 1 , Anita Pillai 1 , Robert Robinson 1 , Shillo Pallai 1 & Ibrahim Shahbuddin 1
1Chesterfield Royal Hospital, Chesterfield, United Kingdom; 2University of Sheffield, Sheffield, United Kingdom
A 24 year old female presented to her general practitioner with general malaise. She had a genetic diagnosis of hereditary non-polyposis colorectal cancer (Lynch syndrome), with no colonic lesions detected on screening. Routine biochemistry revealed a potassium of 2.1mmol/l, requiring admission for urgent investigation and intravenous replacement. Further clinical assessment found a past history of severe acute thoracic back pain (3-months prior to presentation), weight gain and muscle weakness. Clinical examination revealed clear Cushing’s syndrome, including: thinning of the skin, Cushingoid facies, proximal muscle weakness and hypertension (>180/110mmHg). Her inpatient investigations revealed a basal cortisol of >1,000nmol/l, which was not suppressed with an overnight dexamethasone test, and a fully suppressed ACTH. A thoracic spinal x-ray also diagnosed vertebral fractures. In addition to potassium replacement, upon confirmation of hypercortisolaemia the patient was treated with metyrapone, co-trimoxazole (prophylactic dose), antihypertensives and chemical thromboprophylaxis. The patient underwent multiple imaging modalities of the body, including MRI, CT and PET. She was diagnosed with a left adrenocortical cancer (~8 cm). Her metyrapone was titrated to attempt to control her hypercortisolaemia and she was referred for surgery.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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