A Case of Dexamethasone Non-suppressible Cushings Disease Hardly Differentiated from Ectopic ACTH Syndrome
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概要
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A patient with Cushings disease was described who showed non-suppressibilities of plasma ACTH, serum cortisol, and urinary 17-hydroxycorticosteroid (17-OHCS) with a standard dexamethasone suppression test. Serum cortisol was not suppressed even after a larger dose of oral and intravenous dexamethasone (up to 33mg). An intravenous injection of cortisol also failed to suppress the plasma ACTH level. Repeated dexamethasone suppression tests gave similar results. Since the patient had no adrenal tumor but a submucosal tumor of the stomach, ectopic ACTH syndrome was suspected. However, removal of the gastric tumor resulted in no improvement of hypercortisolism. Selective sampling from the petrosal vein showed a higher ACTH concentration than that in the peripheral vein. In addition, the salivary cortisol concentration after 8mg of dexamethasone administration was seen to decrease to 24.7% of the basal level, which was greater than that of serum cortisol and urinary 17-OHCS (65.4 and 78.0%, respectively). She underwent Hardys operation, and adenomatous tissue 2mm in diameter was found and curetted out. However, hypercortisolism recurred after the transient remission. Additional treatments with medical adrenalectomy, pituitary irradiation, and administration of reserpine were carried out. After that, her clinical course was uneventful. We concluded that the determination of salivary cortisol was a reliable tool for evaluation of the response in dexamethasone non-suppressible Cushings disease.
- 社団法人 日本内分泌学会の論文
著者
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HIRAMATSU RYOJI
The 3rd Department of Internal Medicine, Kumamoto University Medical School
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SHIMADA TATSUYA
The 3rd Department of Internal Medicine, Kumamoto University Medical School
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SATO TATSUO
The 3rd Department of Internal Medicine, Kumamoto University Medical School