Cushing Syndrome Caused by Pituitary and Adrenal Hybrid Tumor: A Rare Case Report

Introduction: Cushing syndrome is a rare endocrine disorder caused by a variety of underlying etiologies. It can be due to exogenous or endogenous high cortisone levels (ACTH-dependent or ACTH-independent). We herein report a case of ACTHdependent Cushing syndrome caused by pituitary and adrenal hybrid adenoma. Case report: A 42-year-old female presented with a complaint of hematemesis. She had hirsutism, central obesity and violaceous striae on her abdomen and thigh. On detailed clinical examination and relevant investigation, we found that the cause of hematemesis was esophagitis with necrotic gastric ulcer due to Cushing syndrome caused by the pituitary and adrenal hybrid adenoma. Discussion: Cushing syndrome is a rare endocrine disorder characterized by increased exogenous or endogenous serum cortisol levels, which lead to various clinical presentations. Early identification of the disease and its cause is critical. The entire clinical presentation must be considered for correct diagnosis, which is generally delayed due to the overlapping symptoms of the disease with various specialities. Conclusion: Diagnosis and management of Cushing’s syndrome continues to present considerable challenges and necessitates referral to higher centers. Its diverse presentation warrants a complete clinical, physical, radiological and endocrine examination.