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A Case-Based Guide to Clinical EndocrinologyCushing’s Disease

A Case-Based Guide to Clinical Endocrinology: Cushing’s Disease Chapter 3 Kawaljeet Kaur and James W. Findling Objectives To identify the patient population that should be screened for hypercortisolism, and to understand the approach to the diagnosis, differential diagnosis, and management of Cushing’s syndrome. Case Presentation A 58-year-old white woman presented with multiple nontraumatic metatarsal stress fractures in both feet. She denied recent falls, corticosteroid use, or prolonged immobility. She did report a progressive weight gain of about 20 pounds over the prior 4 years as well as fatigue, sleep disturbance, hypertension, and hyperlipidemia. Physical exam revealed blood pressure of 150/90 mm Hg and a body mass index (BMI) of 27.5. She was not cushingoid (Fig. 3.1). Her skin did not show significant thinning, acanthosis, or striae. There was some facial rounding but no significant supraclavicular fullness. The physical exam was otherwise unremarkable. Her bone mineral density studies done 18 months prior to the visit showed a low bone density in the hip (T score −1.5) and right femoral neck (T score −2.0), and lumbar spine was normal. Family history was negative for any pituitary, adrenal, thyroid diseases, or osteoporosis. Because of the weight gain, hypertension, and low bone density with fractures, endogenous hypercortisolism (Cushing’s syndrome) was considered. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png

A Case-Based Guide to Clinical EndocrinologyCushing’s Disease

Part of the Contemporary Endocrinology™ Book Series
Editors: Davies, Terry F.
Kaur, Kawaljeet; Findling, James W.
A Case-Based Guide to Clinical Endocrinology — Jan 1, 2008
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Publisher
Humana Press
Copyright
© Humana Press,Totowa, NJ 2008
ISBN
978-1-58829-815-7
Pages
27 –33
DOI
10.1007/978-1-60327-103-5_3
Publisher site
See Chapter on Publisher Site

Abstract

Chapter 3 Kawaljeet Kaur and James W. Findling Objectives To identify the patient population that should be screened for hypercortisolism, and to understand the approach to the diagnosis, differential diagnosis, and management of Cushing’s syndrome. Case Presentation A 58-year-old white woman presented with multiple nontraumatic metatarsal stress fractures in both feet. She denied recent falls, corticosteroid use, or prolonged immobility. She did report a progressive weight gain of about 20 pounds over the prior 4 years as well as fatigue, sleep disturbance, hypertension, and hyperlipidemia. Physical exam revealed blood pressure of 150/90 mm Hg and a body mass index (BMI) of 27.5. She was not cushingoid (Fig. 3.1). Her skin did not show significant thinning, acanthosis, or striae. There was some facial rounding but no significant supraclavicular fullness. The physical exam was otherwise unremarkable. Her bone mineral density studies done 18 months prior to the visit showed a low bone density in the hip (T score −1.5) and right femoral neck (T score −2.0), and lumbar spine was normal. Family history was negative for any pituitary, adrenal, thyroid diseases, or osteoporosis. Because of the weight gain, hypertension, and low bone density with fractures, endogenous hypercortisolism (Cushing’s syndrome) was considered.

Published: Jan 1, 2008

Keywords: Salivary Cortisol; Plasma ACTH; Urine Free Cortisol; Inferior Petrosal Sinus; Ectopic ACTH Syndrome

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