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Adrenal Cushing's Syndrome: Diagnosis, Treatment, and Prognosis

This case conference discusses a 36-year-old female presenting with amenorrhea and weight gain. The patient was diagnosed with adrenal Cushing's syndrome and underwent laparoscopic left adrenectomy. The diagnosis, treatment options, and prognosis of adrenal Cushing's syndrome are explored.

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Adrenal Cushing's Syndrome: Diagnosis, Treatment, and Prognosis

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  1. Case Conference 大林慈濟醫院新陳代謝科 郭錦松醫師

  2. Chief Complaint • Amenorrhea for 6 months and weight gain(Feb, 2001) • 36 y/o female 158cm, 58kg (weight gain from 52kg to 58kg)

  3. Physical exams • Moon face (+), supraclavicular pad (+), buffalo hump (-), acne (+), striaes (-) • Goiter (-)

  4. Course 1 • Oct 2000. Irregular menstrual cycle, edema (+) • Feb 2001. Puffy face, no menstrual cycle for 6 months. Normal thyroid functional tests, cortisol 8am =21.0 ug/dl (4.3-22.4), and prolactin level=20.7 ng/ml (male, 2.1-17.7; female, 2.8-29)

  5. Course 2 • Aug 2002: T3=112.7 ng/dl, T4=6.2 ug/dl, TSH=1.038 uIU/ml, cortisol=19.8 ug/dl • Sep 12, 2002. CT of abdomen: left adrenal tumor, 2.5x2.5cm well-defined hypodense mass with homogenous well enhancement • OPD: low dose and high dose dexamethasone suppression test showed compatible with adrenal Cushing syndrome>> arrange operation on Feb 5th, 2003.

  6. Functional tests • 24-hr urine free cortisol=600ug/d (<100ug) • Low-dose dexamethasone suppression test: cortisol level=18.4 ug/dl: • High-dose dexamethasone suppression test: cortisol level=20.2 ug/dl • Cortisol 4pm=21.8 ug/dl

  7. Laparascopic left adrenectomy

  8. Cushing's syndrome • Cushing's disease • adrenal Cushing • Iatrogenic Cushing's syndrome • Ectopic ACTH syndrome

  9. Adrenal Cushing's syndrome • Incidence: 1-2/million per year • Female > male • Most of them are benign

  10. Diagnosis • 24-h urine free cortisol level • 1-mg dexamethasone test • Low-dose dexamethasone test • High-dose dexamethasone test • Midnight serum or saliva cortisol level • ACTH level

  11. Treatment • Adrenectomy • Cortisone replacement s/p operation

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