Cushing’s syndrome is the set of clinical manifestations secondary to a chronic excess of glucocorticoids. Bilateral macronodular adrenal hyperplasia with subclinical cortisol secretion is the most common, but its pr...Cushing’s syndrome is the set of clinical manifestations secondary to a chronic excess of glucocorticoids. Bilateral macronodular adrenal hyperplasia with subclinical cortisol secretion is the most common, but its prevalence remains unknown. We describe a case of bilateral macronodular adrenal hyperplasia. This is a 36-year-old female patient who had been consulting for secondary amenorrhea and developing asthenia for 4 months. The clinical examination noted an overweight patient with high blood pressure, facio-trunk obesity, hirsutism and purple stretch marks in the abdomen and thighs. Biologically, hypokalemia at 2.9 meq/l (3.5 - 5.4), normal calcemia at 90 mg/l (85 - 104), fasting blood sugar was 0.84 g/l (0.7 - 1), the tests for minute, low and high dexamethasone suppression test revealed insufficient suppression of cortisol. The cortisoluria collected from the second day to the third day of the high dexamethasone suppression test was at 186 μg/24 h (<60), the ACTH (Pg/ml) was undetectable (6.4 - 49.8). The diagnosis of an independent adrenocorticotrophin (ACTH) Cushing syndrome was made and the adrenal CT scan revealed bilateral macronodular hyperplasia. A bilateral adrenalectomy was performed and a complete remission of Cushing syndrome was achieved. We prescribed to her, hydrocortisone 20 mg/day and alpha-fludrocortisone 25 to 50 μg/day, This medical observation showed that macro-nodular adrenal hyperplasia with overt Cushing syndrome can occur in the third decade of life. Bilateral adrenalectomy has resulted in a complete cure for Cushing’s syndrome, but may be fraught with complications.展开更多
Introduction: Gonadotroph adenomas are generally nonfunctioning. Hypersecretion of gonadotropins by gonadotroph adenomas rarely induced hypersecretion of testosterone. We report a case of functioning gonadotroph adeno...Introduction: Gonadotroph adenomas are generally nonfunctioning. Hypersecretion of gonadotropins by gonadotroph adenomas rarely induced hypersecretion of testosterone. We report a case of functioning gonadotroph adenoma with secondary hypersecretion of testosterone. Medical Observation: A 25-year-old patient who having had a progressive and bilateral loss of visual acuity for two years. The ophtalmologist’s examination concluded to bitemporal hemianopia. He had no other clinical manifestations of hyper or hypo hormonal secretion. The brain scan has revealed an intrasellar mass with suprasellar development that represses the optic chiasma and the carotids. The assessment carried out revealed an increase in FSH, LH and testosterone. The diagnosis of a functioning gonadotroph macroadenoma with secondary hypersecretion of testosterone was retained. Surgical excision of the adenoma was performed. Anatomo-pathological examination concluded to a pituitary adenoma. The patient showed an improvement in the right visual acuity and developed an adrenal corticotropic insufficiency substituted by hydrocortisone 20 mg per day. The postoperative hormonal profile revealed a normalization of FSH and testosterone. Conclusion: Functioning gonadotroph adenoma with secondary hypersecretion of testosterone is rare. The first-line treatment is surgical and allows an improvement of the cerebral tumor syndrome and the restoration of the gonadotropic function.展开更多
文摘Cushing’s syndrome is the set of clinical manifestations secondary to a chronic excess of glucocorticoids. Bilateral macronodular adrenal hyperplasia with subclinical cortisol secretion is the most common, but its prevalence remains unknown. We describe a case of bilateral macronodular adrenal hyperplasia. This is a 36-year-old female patient who had been consulting for secondary amenorrhea and developing asthenia for 4 months. The clinical examination noted an overweight patient with high blood pressure, facio-trunk obesity, hirsutism and purple stretch marks in the abdomen and thighs. Biologically, hypokalemia at 2.9 meq/l (3.5 - 5.4), normal calcemia at 90 mg/l (85 - 104), fasting blood sugar was 0.84 g/l (0.7 - 1), the tests for minute, low and high dexamethasone suppression test revealed insufficient suppression of cortisol. The cortisoluria collected from the second day to the third day of the high dexamethasone suppression test was at 186 μg/24 h (<60), the ACTH (Pg/ml) was undetectable (6.4 - 49.8). The diagnosis of an independent adrenocorticotrophin (ACTH) Cushing syndrome was made and the adrenal CT scan revealed bilateral macronodular hyperplasia. A bilateral adrenalectomy was performed and a complete remission of Cushing syndrome was achieved. We prescribed to her, hydrocortisone 20 mg/day and alpha-fludrocortisone 25 to 50 μg/day, This medical observation showed that macro-nodular adrenal hyperplasia with overt Cushing syndrome can occur in the third decade of life. Bilateral adrenalectomy has resulted in a complete cure for Cushing’s syndrome, but may be fraught with complications.
文摘Introduction: Gonadotroph adenomas are generally nonfunctioning. Hypersecretion of gonadotropins by gonadotroph adenomas rarely induced hypersecretion of testosterone. We report a case of functioning gonadotroph adenoma with secondary hypersecretion of testosterone. Medical Observation: A 25-year-old patient who having had a progressive and bilateral loss of visual acuity for two years. The ophtalmologist’s examination concluded to bitemporal hemianopia. He had no other clinical manifestations of hyper or hypo hormonal secretion. The brain scan has revealed an intrasellar mass with suprasellar development that represses the optic chiasma and the carotids. The assessment carried out revealed an increase in FSH, LH and testosterone. The diagnosis of a functioning gonadotroph macroadenoma with secondary hypersecretion of testosterone was retained. Surgical excision of the adenoma was performed. Anatomo-pathological examination concluded to a pituitary adenoma. The patient showed an improvement in the right visual acuity and developed an adrenal corticotropic insufficiency substituted by hydrocortisone 20 mg per day. The postoperative hormonal profile revealed a normalization of FSH and testosterone. Conclusion: Functioning gonadotroph adenoma with secondary hypersecretion of testosterone is rare. The first-line treatment is surgical and allows an improvement of the cerebral tumor syndrome and the restoration of the gonadotropic function.
