GIANT «BUFFALO HUMP» AS A SIGN OF CUSHING SYNDROME

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 29-49-Congenital Adrenal Hyperplasia & Ectopic Cushing's
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-46
Natalia Volkova*1, Maria Antonenko2 and Lilia Ganenko3
1Rostov State Med Univ, Rostov on Don, Russia, 2Rostov State Med Univ, Rostov-on-don, Russia, 3Municipal Centre of Endocrinology, Municipal Hospital â„–4, Rostov on Don, Russia
Background: clinical picture of Cushing Syndrome (CS) might be as colorful as asymptomatic. Here we present a case of CS, the clinical picture of which manifested with giant buffalo hump but without any specific signs of hypercortisolism.

Clinical Case: a 53-year-old woman presented with complaints of 24-lb weight gain over the past 2 years without changing lifestyle and giant “buffalo hump”. There had been accomplished to operate it before without any success. Her past medical history was notable for hypertension. Physical examination revealed an apparent increase of fat pad that covered about 70% of dorsal cervicothoracic area. There were no striae, proximal muscle weakness, easy bruising, facial plethora. However, basing on unexplainable weight gain and presence of giant «buffalo hump», there were made decision to screen CS. 1-mg dexamethasone suppression test yielded a serum cortisol of 425nmol/l (cutoff 50nmol/l); midnight plasma cortisol level was 615nmol/L (cutoff 207nmol/L), 24h UFC level was 165μg/24h (reference range, <180 μg/24h), ACTH level was suppressed (< 5 pg/ml). A 4-cm mass in the left adrenal gland was found on computed tomography of the abdomen (unenhanced CT attenuation was -10 HU). Thereby, there was established the diagnosis of ACTH-independent Cushing’s syndrome (adrenal adenoma). There was performed the left adrenalectomy. The histologic picture showed the tumor was composed of tumor clear cells with abundant intracytoplasmic lipid droplets, compact cells with lipid sparse eosinophilic cytoplasm. Postoperatively there was developed adrenal insufficiency. On follow-up 6 months later, the patient lost 24-lb, her blood pressure was in normal range without any medications. Also there was the decrease of fat pad over the cervicothoracic area.

Conclusion: the recent data have showed a number of patients with obesity or T2DM have CS devoid of specific signs of hypercortisolism, so-called «Occult CS». Nowadays, there is no received opinion about whom and how to screen (1). Thus, this situation requires doctors to be more clinically aware.

1)   Tabarin A., Perez P. Nat. Rev. Endocrinol. 2011. № 7 (8). P. 445—55.

Nothing to Disclose: NV, MA, LG

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