1.Cushing's Syndrome in Infancy.
Pyung Kil KIM ; Ki Sup CHUNG ; Duk Jin YUN
Yonsei Medical Journal 1969;10(2):162-169
Cushing's syndrome is very rare in infancy, especially in Korea. We observed a case of Cushing's syndrome in a one year and 2 month old female baby with the complaints of a 3 months history of obesty and hirsutism and 2 months history of polyphagia. There were retarded bone age, hypertension, increased urinary excretion of 17-hydroxycorticosteroid and 17-ketosteroid and eosinopenia but no thymic shadow in the chest X-ray. There was no response to the dexamethasone test (2mg divided in 4 doses orally for 2 days), which suggested an adrenal tumor. Intravenous pyelography showed that the left kidney was displaced downward as compared to the right kidney and there was a henegg sized radio-opaque shadow at the upper pole of the left kidney suggesting a left adrenal tumor. The tumor, reported as a benign adenoma pathologically, was removed successfully by anterior abdominal approach. Hypertension, eosinopenia and hypokalemia were raturned to normal from 3 days after surgery but 17-hydroxycorticosteroid and 17-ketosteroid were returned to normal from 2 weeks after surgery. We have presented this case and have reviewed the literature.
Adenoma/*pathology
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Adrenal Gland Neoplasms/*pathology
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*Adrenalectomy
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Cushing Syndrome/etiology/*surgery
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Female
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Human
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Infant
2.A Case of Cushing's Syndrome in Pregnancy Secondary to an Adrenal Cortical Adenoma.
Hwi Gon KIM ; Kwang Hyun LEE ; Goo Hwa JE ; Myoung Seok HAN
Journal of Korean Medical Science 2003;18(3):444-446
Cushing's syndrome in pregnant women is rare and difficult to be diagnosed because of the syndrome's association with oligomenorrhea or amenorrhea and the changes in cortisol metabolism during normal pregnancy. Cushing syndrome in pregnancy is usually confused with complicated pregnancy, such as preeclampsia or gestational diabetes, and its rarity leads to a low degree of clinical suspicion, often delaying diagnosis. We experienced a case of Cushing's syndrome in pregnancy, which had been considered as the severe preeclampsia and gestational diabetes due to uncontrolled hypertension and hyperglycemia. The pregnancy was terminated with an emergency cesarean operation at 30 weeks of gestation because of severe preeclampsia. In consequence of the evaluation about the Cushing's syndrome after delivery, the adrenal cortical adenoma of right adrenal gland was diagnosed and laparoscopic adrenalectomy was performed.
Adenoma, Adrenal Cortical/*complications/radiography/surgery
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Adrenal Cortex Neoplasms/*complications/radiography/surgery
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Adrenalectomy
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Adult
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Cushing Syndrome/*etiology/radiography/surgery
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Female
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Human
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Pregnancy
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Pregnancy Complications, Neoplastic/*radiography
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Pregnancy Outcome
3.Subclinical Cushing's syndrome:analysis of diagnosis and surgical effect.
Chao FENG ; Han-Zhong LI ; He XIAO ; Wei-Gang YAN ; Yong-Qiang LI ; Wei-Feng XU
Chinese Journal of Surgery 2007;45(24):1691-1693
OBJECTIVETo improve the diagnostic and therapeutic ability on subclinical Cushing's syndrome.
METHODSRetrospective analysis for the clinical data of 24 cases of subclinical Cushing's syndrome, the clinical and biological characters pre and post operation were compared.
RESULTSNone of the 24 cases of subclinical Cushing's syndrome had the classic symptoms and signs of Cushing's syndrome. The common symptoms of these patients were hypertension in 17 cases, diabetes mellitus in 11 cases, hyperlipidemia in 9 cases, high plasma cortisol value in 13 cases and high 24 h UFC value in 9 cases. None of patients did respond to low dose dexamethasone suppression test, but 16 cases of them did not respond to high dose dexamethasone suppression test. All the cases were found adrenal tumors by CT scan, 10 cases in left adrenal and 14 cases in right adrenal. All the patients underwent retroperitoneal laparoscopic operation and were pathologic diagnosed to adrenal adenomas. During follow-up, the symptoms of 20 cases (83.3%) were cured after surgery, and hormone supplement was required in 8 cases.
CONCLUSIONSSubclinical Cushing's syndrome may be incidentally detected on clinical manifestations, laboratory findings and imaging examinations. CT scan, assays of plasma cortisol, urinary free cortisol and dexamethasone suppression test are most useful in the diagnosis. The potential benefit of surgery should be considered in those who have a definite diagnosis of subclinical Cushing's syndrome. Hormone supplement is required in some patients. It is safe and practical to perform retroperitoneal laparoscopic surgery on the patients with subclinical Cushing's syndrome.
Adrenal Cortex Neoplasms ; complications ; surgery ; Adrenalectomy ; methods ; Adrenocortical Adenoma ; complications ; surgery ; Adult ; Cushing Syndrome ; diagnosis ; etiology ; surgery ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome
4.A Case of Cushing's Syndrome Presenting as Endometrial Hyperplasia.
Sang Min LEE ; Jong Ryeal HAHM ; Tae Sik JUNG ; Jung Hwa JUNG ; Mi Yeon KANG ; Sun Joo KIM ; Soon Il CHUNG
The Korean Journal of Internal Medicine 2008;23(1):49-52
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 microgram/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.
Adrenal Cortex Neoplasms/complications/*diagnosis/surgery
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Adrenalectomy
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Adrenocortical Adenoma/complications/*diagnosis/surgery
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Adrenocorticotropic Hormone/blood
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Adult
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Circadian Rhythm
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Cushing Syndrome/*diagnosis/etiology/physiopathology
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Diagnosis, Differential
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Endometrial Hyperplasia/*diagnosis
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Female
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Humans
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Hydrocortisone/secretion/urine
5.Bilateral primary pigmented nodular adrenocortical disease: a case of report describing a rare cause of Cushing's syndrome.
Yong Koo PARK ; Youn Wha KIM ; Jin Woo KIM ; Young Kil CHOI ; Young Tae KO ; Seok Whan KO ; Moon Ho YANG
Journal of Korean Medical Science 1994;9(6):450-457
A case of Cushing's syndrome due to bilateral pigmented nodular adrenal disease in a 35-year-old male is presented. The adrenals showed multiple, black, variable sized nodules. Histologically the cells contained lipofuscin and either had a clear cytoplasm or an eosinophilic cytoplasm with a prominent nucleus. Lymphocytic infiltration and fatty metaplasia within the nodules are two of the prominent histological features. There is extreme internodular atrophy which suggests that primary pigmented nodular adrenocortical disease is a non-adrenocorticotropic hormone dependent condition. Since the disorder appears to involve primarily the cortex of both adrenals, the treatment of choice is bilateral adrenalectomy followed by steroid replacement. The characteristic clinicopathological manifestations that separate this diagnosis from other types of adrenal disease are also discussed. This is the first reported case in Korea to be documented with the pertinent clinicopathological findings.
Adipose Tissue/pathology
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Adrenal Cortex/chemistry/*pathology/radiography/secretion/ultrasonography
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Adrenalectomy
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Adult
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Atrophy
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Case Report
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Cushing Syndrome/*etiology/surgery
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Dexamethasone/diagnostic use
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Furosemide/diagnostic use
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Human
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Hydrocortisone/secretion
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Inflammation
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Lipofuscin/*analysis
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Male
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Metaplasia
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Organelles/ultrastructure
6.A functioning adrenal adenoma and pheochromocytoma in the same adrenal gland: two discrete adrenal incidentalomas.
Ga Eun PARK ; Yoon Young CHO ; Yun Soo HONG ; Su Hoon KANG ; Kyung Ho LEE ; Hyun Woo LEE ; Jae Hyeon KIM
The Korean Journal of Internal Medicine 2015;30(1):114-117
No abstract available.
Adrenal Cortex Function Tests
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*Adrenal Cortex Neoplasms/complications/diagnosis/metabolism/surgery
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*Adrenal Gland Neoplasms/complications/diagnosis/metabolism/surgery
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Adrenalectomy
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*Adrenocortical Adenoma/complications/diagnosis/metabolism/surgery
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Biopsy
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Cushing Syndrome/diagnosis/etiology
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Female
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Humans
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Immunohistochemistry
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*Incidental Findings
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Middle Aged
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*Neoplasms, Multiple Primary/complications/diagnosis/metabolism/surgery
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*Pheochromocytoma/complications/diagnosis/metabolism/surgery
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Predictive Value of Tests
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Tomography, X-Ray Computed
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Treatment Outcome
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Tumor Markers, Biological/metabolism