Difficulty in the diagnosis of Cushing disease.
BACKGROUND
A 48-year-old woman presented to our clinic 1 year after hypertension was discovered on a routine screening visit. During the previous year, she had noticed weight gain in the face and abdomen, easy bruising, oligomenorrhea and facial and periareolar hair growth. On presentation, she reported no weakness, fracture, back pain, depression, irritability, problem with cognition or memory, increased appetite, hot flashes or altered sleep. Previous medication history included 2.5 mg lisinopril daily and 25.0 mg hydrochlorothiazide daily for 12 months.


METHODS
Measurement of urine glucocorticoid excretion, evening plasma and salivary cortisol levels, and basal and corticotropin-releasing-hormone-stimulated adrenocorticotropic hormone and cortisol levels. An overnight 8 mg dexamethasone suppression test, pituitary MRI, inferior-petrosal-sinus sampling, cavernous sinus and jugular venous sampling were performed.


METHODS
Cushing disease.


RESULTS
The patient underwent trans-sphenoidal resection, assessment of remission and subsequent treatment with hydrocortisone.
Nieman
Lynnette K
LK
Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA. niemanl@nih.gov
D015065:17-Hydroxycorticosteroids / Q000652:urine; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D003346:Corticotropin-Releasing Hormone / Q000378:metabolism; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D008875:Middle Aged; D010690:Phlebography; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D010911:Pituitary Neoplasms / Q000378:metabolism / Q000601:surgery; D012463:Saliva / Q000378:metabolism; D013100:Sphenoid Bone / Q000601:surgery
D015065:17-Hydroxycorticosteroids; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone