脳出血後に意識消失とakinetic mutism(無言無動症)を呈した患者でインスリン抵抗性によりみいだされたCushing病の1例

概要

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The patient was 67-year-old diabetic female who had suffered from cerebral hemorrhage followed by unconsciousness, quadriplegia and akinetic mutism 5 years ago. She had been lying on bed in vegetable state after the cerebral hemorrhage. She was treated by small dose of insulin for diabetes mellitus 4 years ago. Her diabetic condition was gradually aggravated during the hospital course and she was required higher dose of insulin administration up to 90 units daily. In February, 2002, she was noticed clinical symptoms of moon face, central obesity, hirsutism and striae cutis on abdominal wall. Several tests of pituitary-adrenal system were carried out. She showed high levels of plasma cortisol at fasting and during forenoon, but the circadian rhythm of plasma cortisol was maintained. However, metyrapone test showed marked increase of urinary 17-OHCS and CRF test demonstrated Prominent elevation of plasma ACTH level accompained by elevation of plasma cortisol. From these clinical findings and laboratory tests, diagnosis of Cushing's disease was established. She was treated by bromocriptine, cyproheptadine and reserpine, but her diabetic condition was not improved and the insulin resistant state has been persisting.
香川県立保健医療大学の論文