title: Cushing's syndrome manifesting as pseudo-central hypothyroidism and hyperosmolar diabetic coma.
abstract: OBJECTIVE
  To report an unusual case of Cushing's syndrome caused by an adrenal pheochromocytoma, manifesting as pseudo-central hypothyroidism and diabetic hyperosmolar coma.
  
  
  METHODS
  A detailed case report is presented, including clinical, laboratory, and radiologic findings as well as results of selective adrenal vein sampling.
  
  
  RESULTS
  In a 69-year-old woman with weight gain and hypothyroidism, diabetes mellitus with hyperosmolar coma developed precipitously. She had mild hypertension, but no diabetes was noted 2 weeks before the hyperosmolar event. Evaluation revealed Cushing's syndrome due to ectopic secretion of adrenocorticotropic hormone from an adrenal pheochromocytoma. After surgical resection of the tumor, the diabetes and the hypertension resolved. Furthermore, the pseudo-central hypothyroidism was eliminated, but primary hypothyroidism was unmasked. This combination has not been reported previously.
  
  
  CONCLUSIONS
  This case illustrates the array of endocrinopathies that can be associated with pheochromocytoma, causing Cushing's syndrome.
authors.affiliation: MIMA Endocrinology, Melbourne, Florida 32901, USA.
authors.forename: Brent R
authors.initials: BR
authors.lastname: Gooch
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000378:metabolism; D000368:Aged; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000209:etiology; D003920:Diabetes Mellitus / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000175:diagnosis* / Q000209:etiology; D007037:Hypothyroidism / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D010673:Pheochromocytoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D015430:Weight Gain
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone