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Difficulty in the diagnosis of Cushing disease

Nature Clinical Practice Endocrinology & Metabolism volume 2, pages 53–57 (2006)Cite this article

Abstract

Background A 48-year-old woman presented to our clinic 1 year after hypertension was discovered on a routine screening visit. During the previous year, she had noticed weight gain in the face and abdomen, easy bruising, oligomenorrhea and facial and periareolar hair growth. On presentation, she reported no weakness, fracture, back pain, depression, irritability, problem with cognition or memory, increased appetite, hot flashes or altered sleep. Previous medication history included 2.5 mg lisinopril daily and 25.0 mg hydrochlorothiazide daily for 12 months.

Investigations Measurement of urine glucocorticoid excretion, evening plasma and salivary cortisol levels, and basal and corticotropin-releasing-hormone-stimulated adrenocorticotropic hormone and cortisol levels. An overnight 8 mg dexamethasone suppression test, pituitary MRI, inferior-petrosal-sinus sampling, cavernous sinus and jugular venous sampling were performed.

Diagnosis Cushing disease.

Management The patient underwent trans-sphenoidal resection, assessment of remission and subsequent treatment with hydrocortisone.

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Figure 1: Abnormal venogram obtained during inferior petrosal-sinus sampling in the patient compared with a normal petrosal-sinus venogram.

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Acknowledgements

These investigations were supported by The National Institute of Child Health and Human Development Intramural Research Program of the NIH.

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Authors and Affiliations

  1. Senior Investigator in the Reproductive Biology and Medicine Branch of the National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA

    Lynnette K Nieman

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  1. Lynnette K Nieman
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Correspondence to Lynnette K Nieman.

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Nieman, L. Difficulty in the diagnosis of Cushing disease. Nat Rev Endocrinol 2, 53–57 (2006). https://doi.org/10.1038/ncpendmet0074

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