A case of Cushing's syndrome presenting as endometrial hyperplasia.
We describe here the case of a 39-year-old woman with a cortisol-producing adrenal adenoma and she presented with endometrial hyperplasia and hypertension without the specific characteristics of Cushing's syndrome. The patient had consulted a gynecologist for menometrorrhagia 2 years prior to her referral and she was diagnosed with endometrial hyperplasia and hypertension. Her blood pressure and the endometrial lesion were refractory despite taking multiple antihypertensives and repetitive dilation and curettage and progestin treatment. On admission, the clinical examination revealed mild central obesity (a body mass index of 22.9 kg/m2, a waist circumference of 85 cm and a hip circumference of 94cm), but there was no hirsutism and myopathy. She showed impaired glucose tolerance on an oral glucose tolerance test. The biochemical hypercortisolemia together with the prolactin and androgen levels were evaluated to explore the cause of her anovulation. Adrenal Cushing's syndrome was confirmed on the basis of the elevated urinary free cortisol (454 microg/24h, normal range: 20-70) with a suppressed ACTH level (2.0 pg/mL, normal range: 6.0-76.0) and the loss of circadian cortisol secretion. A CT scan revealed a 3.1 cm, hyperechoic, well-marginated mass in the left adrenal gland. Ten months post-adrenalectomy, the patient had unintentionally lost 9 kg of body weight, had regained a regular menstrual cycle and had normal thickness of her endometrium.
Lee
Sang Min
SM
Department of Internal Medicine, Gyeongsang National University, College of Medicine, Jinju, Korea.
Hahm
Jong Ryeal
JR
Jung
Tae Sik
TS
Jung
Jung Hwa
JH
Kang
Mi Yeon
MY
Kim
Sun Joo
SJ
Chung
Soon Il
SI
D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D000315:Adrenalectomy; D018246:Adrenocortical Adenoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D002940:Circadian Rhythm; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D003937:Diagnosis, Differential; D004714:Endometrial Hyperplasia / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism / Q000652:urine
D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone