Kimmelstiel-Wilson 症候群に合併した Cushing 氏症候群の一症例
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概要
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We encountered a typical case, female aged 59, of Cushing's syndrome which happened to arise during the course of Kimmelstiel-Wilson syndrome. The patient complained of headache, backache, general tiredness and so on. Main clinical symptoms and signs were 1) the slight exophthalmos, 2) the osteoporosis, mainly in vertebrae and ribs, 3) buffalo hump of the trunk and fullmoon-face, 4) the hypertension (190 systolic: 90 diastolic), 5) Keith-Wagner 6) dry skin and declined resistance to infection, 7) hirsutism, 8) erythremia, 10) muscle atrophy, particularly on the thigh: and so on.<BR>The results of laboratory investigation were the negative syphilitic serological test, 1100 to 1900cc of daily urinary output, no liver damage, the intensely positive Rumpel-Leede test, normal Thorn's test (51.7% reduction by ACTH 25mg intramuscular), normal size of Sella turcica, normal pattern of plasma protein fractions, 222.7mg/dl of blood cholesterol, 10.25mg/dl of blood calcium, 2.25mg/dl of blood magnesium and 2.8 to 4.5mg/day of urinary 17-ketosteroid excretion.<BR>The oral administration of chlorpromazine (37.5mg/day) to this patient eliminated hirsutism and reduced headache. Kimmelstiel-Wilson syndrome has been considered to occur by the hypothalamo-pituitary dysfunction. In this case reported here it seems that some additional disturbance to the hypothalamo-pituitary system produced Cushing's syndrome, some symptoms of which were improved by the chlorpromazine, an inhibitor of central nervous system.
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