Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Study
  • Published:

Cushing's syndrome in women with polycystic ovaries and hyperandrogenism

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 778–783 (2007)Cite this article

Abstract

Background A 41-year-old woman presented to an endocrinology–gynecology clinic having been diagnosed 7 years earlier with polycystic ovarian syndrome on account of hirsutism, subfertility, greasy skin, acne and multiple ovarian cysts. Ovulation induction had led to a successful pregnancy. Subfertility recurred, however, and persisted alongside a new diagnosis of hypertension and progressive weight gain. Upon examination, the patient was hypertensive with facial plethora, rounded facies and violaceous abdominal striae.

Investigations Low-dose dexamethasone test, bedtime salivary and 24-h urinary free cortisol estimations, CT scan of the abdomen, and serum hormone and gonadotropin analyses.

Diagnosis Cushing's syndrome due to a right adrenocortical adenoma.

Management The patient underwent laparoscopic right adrenalectomy, which led to resolution of all symptoms, signs and biochemical abnormalities.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Abdominal CT scan and patient's appearance.

References

  1. Setji TL and Brown AJ (2007) Polycystic ovary syndrome: diagnosis and treatment. Am J Med 120: 128–132

    Article  Google Scholar 

  2. The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 19: 41–47

  3. The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81: 19–25

  4. Nieman LK (2006) Difficulty in the diagnosis of Cushing disease. Nat Clin Pract Endocrinol Metab 2: 53–57

    Article  Google Scholar 

  5. Hammer F and Stewart PM (2006) Cortisol metabolism in hypertension. Best Pract Res Clin Endocrinol Metab 20: 337–353

    Article  CAS  Google Scholar 

  6. Broekmans FJ and Fauser BC (2006) Diagnostic criteria for polycystic ovarian syndrome. Endocrine 30: 3–11

    Article  CAS  Google Scholar 

  7. Kaltsas GA et al. (2004) Secondary forms of polycystic ovary syndrome. Trends Endocrinol Metab 15: 204–210

    Article  CAS  Google Scholar 

  8. Knochenhauer ES et al. (1998) Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab 83: 3078–3082

    CAS  PubMed  Google Scholar 

  9. Newell-Price J et al. (2006) Cushing's syndrome. Lancet 367: 1605–1617

    Article  CAS  Google Scholar 

  10. Glintborg D et al. (2004) Prevalence of endocrine diseases and abnormal glucose tolerance tests in 340 Caucasian premenopausal women with hirsutism as the referral diagnosis. Fertil Steril 82: 1570–1579

    Article  Google Scholar 

  11. Cussons AJ et al. (2005) Polycystic ovarian syndrome: marked differences between endocrinologists and gynaecologists in diagnosis and management. Clin Endocrinol (Oxf) 62: 289–295

    Article  Google Scholar 

  12. Kaltsas GA et al. (2000) How common are polycystic ovaries and the polycystic ovarian syndrome in women with Cushing's syndrome? Clin Endocrinol (Oxf) 53: 493–500

    Article  CAS  Google Scholar 

  13. Murphy M et al. (2006) Polycystic ovarian morphology in normal women does not predict the development of polycystic ovary syndrome. J Clin Endocrinol Metab 91: 3878–3884

    Article  CAS  Google Scholar 

  14. Balen AH et al. (1995) Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod 10: 2107–2111

    Article  CAS  Google Scholar 

  15. Invitti C et al. (1991) Increased urinary free cortisol and decreased serum corticosteroid-binding globulin in polycystic ovary syndrome. Acta Endocrinol (Copenh) 125: 28–32

    Article  CAS  Google Scholar 

  16. Putignano P et al. (2003) Screening for Cushing's syndrome in obese women with and without polycystic ovary syndrome. J Endocrinol Invest 26: 539–544

    Article  CAS  Google Scholar 

  17. Invitti C et al. (1998) Altered morning and nighttime pulsatile corticotropin and cortisol release in polycystic ovary syndrome. Metabolism 47: 143–148

    Article  CAS  Google Scholar 

Download references

Acknowledgements

N Krone is a Wellcome Trust Clinician Scientist. NA Hanley received support as a UK Department of Health Clinician Scientist. Written consent for publication of Figure 1 was obtained from the patient.

Author information

Authors and Affiliations

  1. PG Fegan is a Wessex Region Specialist Registrar in Diabetes and Endocrinology.,

    P Gerry Fegan

  2. DD Sandeman is a Consultant Endocrinologist and PJ Wood is a Consultant Biochemist at Southampton University Hospitals NHS Trust, Southampton, UK.,

    Derek D Sandeman & Peter J Wood

  3. N Krone is a Wellcome Trust Clinician Scientist Fellow and PM Stewart is Professor of Medicine, at the University of Birmingham, Birmingham, UK.,

    Nils Krone & Paul M Stewart

  4. D Bosman is a Consultant Endocrinologist at The Royal West Sussex Trust, Chichester, UK.,

    Deborah Bosman

  5. NA Hanley is Professor of Endocrinology, at the University of Southampton, UK.,

    Neil A Hanley

Authors
  1. P Gerry Fegan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Derek D Sandeman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nils Krone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Deborah Bosman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter J Wood
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paul M Stewart
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Neil A Hanley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Neil A Hanley.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fegan, P., Sandeman, D., Krone, N. et al. Cushing's syndrome in women with polycystic ovaries and hyperandrogenism. Nat Rev Endocrinol 3, 778–783 (2007). https://doi.org/10.1038/ncpendmet0665

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpendmet0665

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing