Bala, Margarita and Guralnik, Viktoria and Schuierer, Gerhard and Ullrich, Winfried and Schoelmerich, Juergen and Schaeffler, Andreas (2008) Reversible Metabolic Syndrome. MEDIZINISCHE KLINIK, 103 (10). pp. 736-740. ISSN 0723-5003,
Full text not available from this repository. (Request a copy)Abstract
A 52-year-old male patient was admitted to the emergency department with dyspnea and hypertensive urgency. During the previous 6 months, the patient had noticed leg edema, weight gain (particularly in the face and abdomen), and impotence. 1.5 years ago, he was diagnosed with hypertension resistant to medication. After an accident at work 1 year ago, osteoporosis was diagnosed with vertebral and rib fractures. Measurement of sleeping midnight salivary cortisol levels together with 24-h urine free cortisol excretion and an overnight low-dose 1-mg dexamethasone suppression test proved overt hypercortisolism. The high-dose 8-mg dexamethasone suppression suggested an adrenal or ectopic source of hypercortisolism. By contrast, elevated adreno-corticotropic hormone (ACTH) levels and a corticotropin-releasing hormone stimulation test gave evidence for a pituitary source of hypercortisolism. However, pituitary magnetic resonance imaging failed to reveal a pituitary adenoma. Moreover, computed tomography scans of thorax and abdomen were negative. In this situation, an inferior petrosal vein sampling was performed and revealed an ACTH gradient (central-systemic) > 3 with lateralization to the right side. The patient underwent a selective, partial, transsphenoidal resection and was cured from clinical signs and symptoms caused by hypercortisolism. Subsequent hormonal replacement therapy of postoperative pituitary insufficiency was necessary.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | DEPENDENT CUSHINGS-SYNDROME; DIFFERENTIAL-DIAGNOSIS; PITUITARY; Hypercortisolism; Cushing's disease; Inferior petrosal vein sampling |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin I Medicine > Lehrstuhl für Neurochirurgie Medicine > Lehrstuhl für Röntgendiagnostik |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 23 Oct 2020 07:02 |
| Last Modified: | 23 Oct 2020 07:02 |
| URI: | https://pred.uni-regensburg.de/id/eprint/30242 |
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