Marked elevation of serum dehydroepiandrosterone sulphate in Cushing's disease with macronodular adrenocortical hyperplasia.
A 30-year-old man presented with longstanding hypercortisolism and biochemical studies typical of pituitary-dependent Cushing's disease. After unsuccessful transsphenoidal surgery, plasma ACTH transiently became undetectable and adrenal computed tomography (CT) was consistent with macronodular hyperplasia. Serum dehydroepiandrosterone sulphate (DHEA-S) exceeded 10,000 ng/ml (normal 2,000-3,350 ng/ml). Despite either transient adrenal autonomy or variable adrenocortical ACTH hyperresponsiveness, urinary cortisol normalized within eight months following pituitary irradiation alone. Serum DHEA-S fell progressively but remained mildly elevated (4,000 ng/ml). Follow-up CT showed minimal residual adrenal nodularity. Given these findings and a review of the literature, we propose that chronic cosecretion of non-ACTH proopiomelanocortinderived peptides may have stimulated both hypersecretion of DHEA-S and adrenocortical macronodularity in this patient.
Jackson
J A
JA
Department of Medicine, Scott and White Clinic, Temple, Texas 76508.
Fachnie
J D
JD
Mellinger
R C
RC
D000303:Adrenal Cortex Diseases / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000328:Adult; D003480:Cushing Syndrome / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D003687:Dehydroepiandrosterone / Q000031:analogs & derivatives* / Q000097:blood; D019314:Dehydroepiandrosterone Sulfate; D006801:Humans; D006965:Hyperplasia; D008297:Male; D010900:Pituitary Diseases / Q000150:complications / Q000175:diagnosis* / Q000532:radiotherapy; D011859:Radiography
D003687:Dehydroepiandrosterone; D019314:Dehydroepiandrosterone Sulfate