title: Cushing syndrome related to leukemic infiltration of the central nervous system: a case report and a possible role of LIF.
abstract: BACKGROUND
  Adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome (CS) in the presence of leukemic central nervous system infiltration is very rare.
  
  
  METHODS
  A 3.8-year-old girl who had been treated for B-cell acute lymphoblastic leukemia (ALL) for 1.5 years was admitted to our hospital with excessive weight gain and depression for the last 2 months. Prior to her admission, she was on maintenance with the ALL-BFM95 study protocol for 10 months that does not contain corticosteroids. On physical examination, central obesity and moon face appearance were determined. Laboratory tests revealed high morning ACTH, cortisol level, and 24-h urinary free cortisol level. Morning cortisol level was 33.94 nmol/L after a 2-day (4 × 0.5 mg) dexamethasone suppression test. A lumbar puncture revealed leukemic cells in the cerebrospinal fluid. No pituitary adenoma was detected on magnetic resonance imaging. We diagnosed the patient with ACTH-dependent CS related to leukemic infiltration of the central nervous system.
  
  
  CONCLUSIONS
  Central nervous system infiltration should be considered in leukemic patients who have developed CS. We believe increased leukemia inhibitory factor levels may be a factor for CS in our patient with ALL.
authors.forename: Nursel Muratoglu
authors.initials: NM
authors.lastname: Sahin
authors.forename: Zekai
authors.initials: Z
authors.lastname: Avci
authors.forename: Baris
authors.initials: B
authors.lastname: Malbora
authors.forename: Ayhan
authors.initials: A
authors.lastname: Abaci
authors.forename: Sibel Tulgar
authors.initials: ST
authors.lastname: Kinik
authors.forename: Namik Yasar
authors.initials: NY
authors.lastname: Ozbek
mesh_terms: D001752:Blast Crisis / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000523:psychology; D002471:Cell Transformation, Neoplastic / Q000378:metabolism*; D016543:Central Nervous System Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000523:psychology / Q000556:secondary*; D002675:Child, Preschool; D003480:Cushing Syndrome / Q000209:etiology* / Q000378:metabolism; D003863:Depression / Q000209:etiology; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D053605:Leukemia Inhibitory Factor / Q000378:metabolism*; D015448:Leukemia, B-Cell / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D017254:Leukemic Infiltration / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology* / Q000523:psychology; D060046:Maintenance Chemotherapy; D008954:Models, Biological; D056128:Obesity, Abdominal / Q000209:etiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D012008:Recurrence; D015430:Weight Gain
chemical_list: C507837:LIF protein, human; D053605:Leukemia Inhibitory Factor