Endocrine Abstracts

Introduction: Cushing syndrome is a rare endocrine disorder caused by excess cortisol production, leading to a constellation of symptoms and physical features. Primary adrenal tumors account for 10-20% of cases of Cushing syndrome. Most of these patients have benign adrenocortical adenomas, and rarely adrenal carcinoma or nodular adrenal hyperplasia

Case report: A 25-year-old female undergraduate presented with a six-month history of unintentional weight gain. There was associated easy fatigability, especially when climbing the stairs. There is no history of cough, orthopnea, paroxysmal nocturnal dyspnea, or leg swelling. There was a positive history of easy bruising and purplish stretch marks on her tummy. She admits to a history of abdominal pain, located on the right side of her tummy. No diarrhoea, vomiting, darkening of the skin, excessive acne, or male pattern of hair distribution. No history of exogenous steroid use or family history of similar symptoms. Examination revealed a young woman, with moon-face, facial plethora, buffalo hump, truncal obesity, and multiple purplish striae on her abdomen. Her weight was 80 kg and height 1.63m with a body mass index (BMI) of 30.1 kg/m², with a waist-hip ratio of 0.92. Gowers’ sign was positive and blood pressure was 110/90mmHg. The investigations’ results show non-suppression of cortisol following overnight low-dose dexamethasone suppression test, failure of cortisol suppression by 50% or more following overnight high-dose dexamethasone suppression test, and inappropriately low basal ACTH. Abdominal MRI revealed a near oval-shaped mass measuring 14.8mm x 25.4mm (TxAP) in the right suprarenal region separate from the right kidney. Cortisol secretion was controlled before surgery, open right adrenalectomy, with histologic confirmation of adrenal adenoma. Clinical symptoms improved with the normalisation of basal serum cortisol.

Conclusion: Adrenal Cushing’s syndrome is a rare but important diagnosis in patients with hypercortisolism. Early recognition and surgical intervention can significantly improve the quality of life.