[Cushing's syndrome--unusual cases].
The separation of Cushing's disease from non-pituitary ACTH-secreting tumors is rarely straightforward. Both a 16-year-old girl and a 56-year-old man exhibited typical clinical features of Cushing's syndrome. In both patients urinary 17OHCS was suppressed by 8mg dexamethasone and plasma cortisol and ACTH responded to intravenous administration of CRH. X-rays of the skull, a computed tomographic scan and a magnetic resonance imaging (MRI) of the sella turcica area showed no significant abnormality. An enhanced MRI of the pituitary gland in the first patient demonstrated a small low-density area which represented microadenoma. In the second patient, an enhanced MRI and inferior sinus sampling failed to demonstrate a pituitary tumor. The patient died of acute myocardial infarction, and an autopsy revealed a bronchial carcinoid in the right upper pulmonary lobe. It is necessary to differentiate an ectopic ACTH-secretion in patients with Cushing's syndrome who show typical biochemical features of Cushing's disease but fail to demonstrate the presence of a pituitary tumor by routine radiological evaluation.
First Department of Internal Medicine, Toho University School of Medicine.
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Miyachi
D000182:ACTH Syndrome, Ectopic / Q000175:diagnosis / Q000209:etiology; D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D001984:Bronchial Neoplasms / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D002276:Carcinoid Tumor / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D003346:Corticotropin-Releasing Hormone; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis / Q000378:metabolism
D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone