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[Reversible metabolic syndrome].
- Source :
-
Medizinische Klinik (Munich, Germany : 1983) [Med Klin (Munich)] 2008 Oct 15; Vol. 103 (10), pp. 736-40. Date of Electronic Publication: 2008 Oct 21. - Publication Year :
- 2008
-
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.
- Subjects :
- ACTH Syndrome, Ectopic surgery
ACTH-Secreting Pituitary Adenoma surgery
Adenoma surgery
Cushing Syndrome surgery
Diagnosis, Differential
Endoscopy
Humans
Hypophysectomy
Male
Metabolic Syndrome etiology
Metabolic Syndrome surgery
Middle Aged
Petrosal Sinus Sampling
ACTH Syndrome, Ectopic diagnosis
ACTH-Secreting Pituitary Adenoma diagnosis
Adenoma diagnosis
Cushing Syndrome diagnosis
Metabolic Syndrome diagnosis
Subjects
Details
- Language :
- German
- ISSN :
- 0723-5003
- Volume :
- 103
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Medizinische Klinik (Munich, Germany : 1983)
- Publication Type :
- Academic Journal
- Accession number :
- 18936899
- Full Text :
- https://doi.org/10.1007/s00063-008-1114-z