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    Cushing's Syndrome

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    Rahmah Shah Bahai
    This document presents the case of a 36-year-old Saudi female who was referred for persistent hypokalemia and had a 3-month history of progressively worsening bilateral lower limb weakness. Her examination revealed signs of Cushing's syndrome including hirsutism, acne, and dorsocervical fat deposition. Laboratory tests found elevated cortisol levels that did not suppress with dexamethasone testing, indicating Cushing's disease. Brain MRI revealed a pituitary mass compressing the optic chiasm, consistent with a Rathke's cleft cyst complicated by hemorrhagic degeneration of a pituitary macroadenoma. She was diagnosed with ACTH-dependent Cushing's syndrome secondary to a pituitary adenoma

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    Cushing's Syndrome

    Uploaded by

    Rahmah Shah Bahai
    346 views25 pages
    This document presents the case of a 36-year-old Saudi female who was referred for persistent hypokalemia and had a 3-month history of progressively worsening bilateral lower limb weakness. Her examination revealed signs of Cushing's syndrome including hirsutism, acne, and dorsocervical fat deposition. Laboratory tests found elevated cortisol levels that did not suppress with dexamethasone testing, indicating Cushing's disease. Brain MRI revealed a pituitary mass compressing the optic chiasm, consistent with a Rathke's cleft cyst complicated by hemorrhagic degeneration of a pituitary macroadenoma. She was diagnosed with ACTH-dependent Cushing's syndrome secondary to a pituitary adenoma

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    Cushing's Syndrome

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    This document presents the case of a 36-year-old Saudi female who was referred for persistent hypokalemia and had a 3-month history of progressively worsening bilateral lower limb weakness. Her examination revealed signs of Cushing's syndrome including hirsutism, acne, and dorsocervical fat deposition. Laboratory tests found elevated cortisol levels that did not suppress with dexamethasone testing, indicating Cushing's disease. Brain MRI revealed a pituitary mass compressing the optic chiasm, consistent with a Rathke's cleft cyst complicated by hemorrhagic degeneration of a pituitary macroadenoma. She was diagnosed with ACTH-dependent Cushing's syndrome secondary to a pituitary adenoma

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    346 views25 pages

    Cushing's Syndrome

    Uploaded by

    Rahmah Shah Bahai
    This document presents the case of a 36-year-old Saudi female who was referred for persistent hypokalemia and had a 3-month history of progressively worsening bilateral lower limb weakness. Her examination revealed signs of Cushing's syndrome including hirsutism, acne, and dorsocervical fat deposition. Laboratory tests found elevated cortisol levels that did not suppress with dexamethasone testing, indicating Cushing's disease. Brain MRI revealed a pituitary mass compressing the optic chiasm, consistent with a Rathke's cleft cyst complicated by hemorrhagic degeneration of a pituitary macroadenoma. She was diagnosed with ACTH-dependent Cushing's syndrome secondary to a pituitary adenoma

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    Case presentation

    Done by: Dr. Rahma ShahBahai


    Medical intern

    History
    36 y.o single Saudi female k/c of HTN, T2DM and dyslipidemia
    Direct admission from OPD.
    Presented with lower back pain, headache and inability to
    walk for 3 months.
    referred from KFH (Hafof) for persistent hypokalemia for
    further investigation.

    HPI:
    3 months Hx of progressive bilateral lower limbs weakness.
    Start as a simple weakness>>cant carry her weight during
    standing>>become wheelchair bound.
    Headache and lower back pain.
    No Hx of sphincter incontinence.

    Drug Hx:
    Aldactone 50 mg PO BID
    Nifedipine 40 mg PO OD
    Hydralazine 50 mg PO Q6H
    Atorvastatin 20 mg PO OD
    Labetalol 100 mg PO BID
    Diamicron 90 mg PO OD

    PH:
    uncontrolled HTN >10 years
    Dyslipidemia+T2DM ~3month
    2ry Amenorrhea ~15 yrs.
    Her menarche @ 13>> stopped
    didn't seek medical advice.
    No surgical Hx.

    FH:
    father in good health.
    Mother >>HTN
    Sis1: HTN+DM
    Sis 2: passed away (leukemia)
    sis 3: weight gain+2ry amenorrhea

    Systemic review:
    No mood changes
    No dizziness
    No blurred vision
    excessive hair growth
    acne
    No respiratory or cardiac symptoms
    No nausea, vomiting, diarrhea or constipation
    No urinary symptoms

    D.Dx ???

    Examination

    General:

    Obese, round face, comfortable in the bed, not in distress.

    Vitals: T 37.7 ,p 90, RR 18, BP 160/100

    Skin:

    hirsutism, facial plethora, acne, dorsocervical fat deposition, supraclavicular


    fat deposition.

    Chest: clear, good air entry bilateral.

    CVS: S1,S2+0

    Abdomen: distended, White striae ~0.5-0.7 cm, positive bowel sound.

    CNS: conscious, alert

    Extremities: bruises
    U.L: power 4/5, reflexes normal
    L.L: muscles wasting, bruises, no edema, power 3/5, reflexes normal

    Labs:
    Cbc
    Liver panel
    Renal/lyte
    Lipid profile
    All within her base line, except for:
    K 2.5

    Hospital course
    Pt. loss of her consciousness < 1min.
    Notice abnormal movement, not typical for convulsion
    K 2.4
    ICU transferred.
    Observation, K-replacement, ECG

    Investigations???

    Labs:

    Cortisol level am 313.6

    Cortisol level pm 2017.8

    ACTH 31

    DST 331

    FT4 13.5

    FT3 2.44

    T3H 0.09(SET)

    E2 142

    LH <0.07

    FSH 0.09

    Brain CT:
    cystic density 20*20 nm seen
    compressing the pituitary gland

    Brain MRI:
    cystic mass lesion 2.5*1.7 cm with evidence of
    hemorrhagic is seen, optic chiasma is
    displaced cronaly
    Finding consistent rathke cleft cyst
    complicated by hemorrhagic or cystic
    degeneration of pituitary macro-adenoma.

    Diagnosis is..?
    ACTH-dependent Cushings syndrome

    Harvey Williams Cushing

    Cushings Syndrome= Hypercortisolism

    Cushing's disease= Cushing's syndrome 2ry to pituitary ACTH


    hypersecretion

    Etiologies:
    Iatrogenic= exogenous glucocorticoid>>most
    common
    Cushings disease= endogenous 70%
    Pituitary adenoma/hyperplasia

    Adrenal tumor 25%


    Ectopic ACTH 10%:
    Carcinoid, SCLC, medullary thyroid cancer, pheo.

    Approach

    TTT..
    Mainly>>surgical resection
    Medication
    Replacement therapy lifelong.

    Thank you.

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