CUSHING AND PSEUDOCUSHING STATE IN THE SAME PATIENT

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 164-196-Pituitary
Basic/Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-184
Natalia Volkova*1 and Maria Antonenko2
1Rostov State Med Univ, Rostov on Don, Russia, 2Rostov State Med Univ, Rostov-on-don, Russia
Background: pseudoCushing states pose a great challenge in distinguishing with Cushing Syndrome (CS). Patients who have already had CS in anamnesis represent the most difficult cases.

Clinical case: the patient female 32 y.o. was diagnosed with Cushing disease (CD) in 2006 when typical signs appeared (weight gain, face plethora, «buffalo hump», amenorrhea). There was performed transnasal adenomectomy, and, postoperatively, there developed adrenal failure. During 6 months patient returned to her normal physical state. In 2009 there was diagnosed recurrence of CD when the negative laboratory and imaging dynamics were fixed. Due to absence of typical clinic, patient refused to be operated. In 2011 there was overt clinic with weight gain, increase of dorsocervical fatpad, proximal muscle weakness. Transnasal surgery was performed and 2 microadenomas were removed. Postoperative adrenal failure didn’t develop. After 6 months there were no symptoms of CS and laboratory test results (1-mg DST, midnight plasma cortisol, cortisol circadian rhythm secretion, 24-h UFC) were in reference range. In 2012 the patient presented with complaints of weight gain and depressed mood. There was performed the assessment of HPA axis. Plasma cortisol after 1-mg DST was 7,9nmol/l (cutoff 50nmol/l), midnight plasma cortisol 342,24 nmol/l (cutoff 207nmol/l), cortisol circadian rhythm secretion 75% (cutoff 50%), 24-h UFC 280mcg/24h (laboratory reference range 40-180mcg/24h). Because of depressed mood, the patient was seen by psychiatrist, and there was established major depression. Due to the absence of CRH in Russia, there was no ability to provide the dexamethasone-CRH test to distinguish between CS and pseudoCushing state as the result of depression. There was poor clinical expression comparing with previous recurrence of Cushing disease, as well as an absence of negative dynamics on MRI. Thus, the altered HPA axis was considered consequence of depression and interpreted as a pseudoCushing state. The patient was advised to take SSRI for 6 months with following assessment of HPA axis. After 6 months of therapy with antidepressants, the test results (1-mg DST, midnight plasma cortisol, cortisol circadian rhythm secretion, 24-h UFC) were in reference ranges. Nowadays, patient is in remission state.

Conclusion: detection of pseudoCushing states in patients with previous CS is of great importance, and it requires even more clinical analysis than specific laboratory tests.

Nothing to Disclose: NV, MA

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