Cushing sendromunda (CS) kardiyovasküler hastalıklar ve osteoporoz nedeni ile mortalite ve morbidite artmaktadır. Klinik bulgular ve mortalite hiperkortizoleminin şiddeti ve süresi ile ilişkilidir. Biz CS tanısının gecikmesinden kaynaklanan ciddi komplikasyonlarla başvuran bir olguyu sunduk. Elli iki yaşındaki erkek hasta bacaklarda şişlik, nefes darlığı ve bel ağrısı şikayetleri ile başvurdu. Özgeçmisinde 2 yıldır çoklu antihipertansif tedavi ve yoğun insülin tedavisine rağmen kontrol altına alınamayan hipertansiyon ve diyabet ile 6 aydır kalp yetmezliği mevcuttu. Fizik muayenede pletore, bufalo hörgücü, abdominal obezite, karında mor strialar, pretibial ödem saptandı. Laboratuvar incelemesinde adrenokortikotropik hormon (ACTH)
Cushings syndrome (CS) is associated with increased morbidity and mortality due to cardiovascular diseases and osteoporosis. Clinical findings and mortality are related to degree and duration of hypercortisolism. We report a patient with CS who presented with severe complications resulting from delayed diagnosis. A 52-year-old male with a two-year history of uncontrolled diabetes mellitus and hypertension and a six-month history of heart failure was admitted with leg edema, dyspnea, and back pain. His physical examination revealed plethora, abdominal obesity, and abdominal purple striae. Laboratory analysis revealed the following results: adrenocorticotropic hormone: <5 pg/ml, morning plasma cortisol: 26.33 μg/dl, night plasma cortisol: 26.38 μg/dl, and urine cortisol: 272 μg/24 hour. No suppression was detected in the plasma cortisol of 2 mg and 8 mg dexamethasone suppression tests (30.7 μg/ dl and 35.54 μg/dl, respectively). Echocardiography showed low ejection fraction (40%), X-ray demonstrated vertebral fractures. Adrenal CT revealed a 4x4 cm left adrenal mass. The patient underwent left adrenalectomy. Histopathological diagnosis was adrenocortical adenoma. After the operation, a partial recovery was detected in his diabetes mellitus, hypertension, and osteoporosis. An operation was planned for vertebral fractures. Clinicians should keep in mind the presence of CS when diabetes and hypertension are more severe and treatment-resistant. A delay in diagnosis can lead to serious complications that can result in death. (The Medical Bulletin of Haseki 2015; 53: 256-9)
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