Ciddi Kalp Yetmezliği ve Vertebra Kırıkları ile Tanı Alan Cushing Sendromu Olgusu

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)

A Case of Cushing’s Syndrome Presented with Severe Heart Failure and Multiple Vertebral Fractures

Cushing’s 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 &#956;g/dl, night plasma cortisol: 26.38 &#956;g/dl, and urine cortisol: 272 &#956;g/24 hour. No suppression was detected in the plasma cortisol of 2 mg and 8 mg dexamethasone suppression tests (30.7 &#956;g/ dl and 35.54 &#956;g/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)

Kaynakça

1. Brown RL, Weiss RE. An approach to the evaluation and treatment of Cushing’s disease Expert Rev Anticancer Ther 2006;9:37-46.

2. Canalis E, Mazziotti G, Giustina A, Bilezikian JP. Glucocorticoid- induced osteoporosis: pathophysiology and therapy. Osteoporos Int 2007;18:1319-28.

3. Newell-Price J. Diagnosis/differential diagnosis of Cushing’s syndrome: a review of best practice. Best Pract Res Clin Endocrinol Metab 2009;23(Suppl 1):5-14.

4. Yanovski JA, Cutler Jr GB. Glucocorticoid action and the clinical features of Cushing’s syndrome. Endocrinol Metab Clin North Am 1994;23:487-509.

5. Arnaldi G, Angeli A, Atkinson AB, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 2003;88:5593-602.

6. Prague JK, May S, Whitelaw BC. Cushing’s syndrome. BMJ 2013;27:346:945.

7. De P, Evans LM, Scanlon MF, Davies JS. “Osler’s phenomenon”: misdiagnosing Cushing’s syndrome. Postgrad Med J 2003;79:594-6.

8. Cavagnini F, Pecori Giraldi F. Epidemiology and follow-up of Cushing’s disease. Ann Endocrinol (Paris) 2001;62:168-72.

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10. Carroll TB, Findling JW. The diagnosis of Cushing’s syndrome. Rev Endocr Metab Disord 2010;11:147-53.

11. Ross EJ, Linch DC. Cushing’s syndrome--killing disease: discriminatory value of signs and symptoms aiding early diagnosis. Lancet 1982;2:646-9.

12. Nieman LK, Biller BM, Findling JW, et al. The diagnosis of cushing’s syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008;93:1526-40.

13. Mancini T, Kola B, Mantero F, Boscaro M, Arnaldi G. High cardiovascular risk in patients with Cushing’s syndrome according to 1999 WHO/ISH guidelines. Clin Endocrinol (Oxf) 2004;61:768-77.

14. Lindholm J, Juul S, Jørgensen JO, et al. J Incidence and late prognosis of cushing’s syndrome: a population-based study. J Clin Endocrinol Metab 2001;86:117-23.

15. Etxabe J, Vazquez JA. Morbidity and mortality in Cushing’s disease: an epidemiological approach. Clin Endocrinol (Oxf) 1994;40 479-84.

16. Neary NM, Booker OJ, Abel BS, et al. Hypercortisolism is associated with increased coronary arterial atherosclerosis: analysis of noninvasive coronary angiography using multidetector computerized tomography. J Clin Endocrinol Metab 2013;98:2045-52.

17. Di Somma C, Pivonello R, Loche S, et al. Effect of 2 years of cortisol normalization on the impaired bone mass and turnover in adolescent and adult patients with Cushing’s disease: a prospective study. Clin Endocrinol (Oxf) 2003;58:302-8.

Kaynak Göster

  • ISSN: 1302-0072
  • Yayın Aralığı: Yılda 5 Sayı
  • Başlangıç: 2005

3.4b 1.9b

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