A case of pituitary dependent Cushing's disease with clinical and biochemical features of the ectopic ACTH syndrome.
A case of atypical pituitary dependent Cushing's disease is reported. The patient presented with clinical symptoms similar to those of the ectopic ACTH syndrome; notably a marked hypokalaemic alkalosis, widely fluctuating plasma cortisol levels, greatly elevated plasma ACTH levels, and failure to suppress both plasma cortisol and ACTH levels following high dose oral dexamethasone. However, a large aggressive pituitary tumour was detected by skull X-ray and computed tomography. Removal of the pituitary tumour led to full remission of the patient's Cushing's syndrome. Pro-opiomelanocortin (POMC) related peptides in the plasma and tumour tissue extract of this patient have been characterized by gel-filtration and Concanavalin-A Sepharose affinity chromatography, indicating processing of POMC in a manner more usually associated with ectopic tumours.
Hale
A C
AC
Millar
J B
JB
Ratter
S J
SJ
Pickard
J D
JD
Doniach
I
I
Rees
L H
LH
D000182:ACTH Syndrome, Ectopic / Q000209:etiology* / Q000378:metabolism; D000237:Adenoma, Basophil / Q000150:complications* / Q000378:metabolism; D000324:Adrenocorticotropic Hormone / Q000032:analysis; D000368:Aged; D002846:Chromatography, Affinity; D002850:Chromatography, Gel; D003480:Cushing Syndrome / Q000209:etiology* / Q000378:metabolism; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D009074:Melanocyte-Stimulating Hormones / Q000032:analysis; D009384:Paraneoplastic Endocrine Syndromes / Q000209:etiology*; D010911:Pituitary Neoplasms / Q000150:complications* / Q000378:metabolism
D000324:Adrenocorticotropic Hormone; D009074:Melanocyte-Stimulating Hormones