The challenge of clinical management of Cushing’s disease: case report

Authors

DOI:

https://doi.org/10.33448/rsd-v11i13.35218

Keywords:

Cushing's Syndrome; Glucocorticoids; Hydrocortisone.

Abstract

Cushing's disease is caused by the corticotrophic pituitary adenoma which increases the level of cortisol and consequently blood glucose levels and the deposition of fat in tissues and organs. This study proposes to report the case of a patient with this rare pathology in order to understand the syndrome that hypercortisolism/adenoma results in and discuss the clinical challenge. This is a case study whose data were obtained by evaluating the patient's medical records, analyzing the diagnostic tests performed and reviewing the literature. The 21-year-old patient complained of difficult-to-control obesity. Physical examination, laboratory and imaging tests were performed, which led to the diagnostic hypothesis of pituitary adenoma. After the surgical removal procedure, the material was sent to the anatomopathological examination for biopsy, which confirmed the diagnosis of corticotrophic pituitary adenoma. It is necessary to pay attention to the clinical abnormalities caused by excess cortisol related to the diagnosis, considering the need for a multidisciplinary treatment.

References

Canda, C. M. N. Oliveira, R. M., Parente, T. M. C. M., Luiz, W., & Sanzana, L. R. Z. (2020). Acth pituitary macro adenoma evolving of secretor with cushing's disea se: case report. Revista de Patologia do Tocantins, Palmas, 7(3), 63-8. https://sistemas.uft.edu.br/periodicos/index.php/patologia/article/view/6536/17631.

Carvalho, L. A. N. de, Cruz, M. D. M., Santos, J. P. L. C. dos, Barbosa, I. R., Oliveira, P. H. F de, Carvalho, N. O. de ...& Franco, F. S.(2021). Síndrome de cushing e hipercortisolismo associado: uma revisão literária. Brazilian Journal of Development, 7(6), p. 61473-61484.

Castañeda, J., Mora, H., Torres, L., Criollo, J., Sola, J., & Cedeño, W. (2018). Evolución de pacientes con adenoma hipofisario después de resección quirúrgica vía transesfenoidal en Hospital Teodoro Maldonado. Revista científica INSPILIP, Guayaquil, Ecuador, 2(1), 1-14.

Castro, M., & Moreira, A. C. (2002). Diagnóstico laboratorial da síndrome de Cushing. Arquivos Brasileiros Endocrinologia e Metabolismo, São Paulo, 46(1), 1-9.

Damasceno, S. A. N., Freitas, E. P de P., Silva, J. de M., Pereira, T. M. A., Orsini, M., & Bastos, V. H. do V. (2019). Doença de Cushing: Revisão Integrativa, Revista de Saúde, Vassouras, 10(2), 76-81. http://webcache.googleusercontent.com/search?q=cache:kxzxpQAitIQJ:editora.universidadedevassouras.edu.br/index.php/RS/article/view/2022/1242+&cd=1&hl=pt-BR&ct=clnk&gl=br.

Dinza Cabrejas, E. L., López, J. A. M., Porrata, L. M. P. & Gómez, O. G. (2017). Resonancia magnética en pacientes con tumoresmmás frecuentes en la región selar. MEDISAN, Santiago de Cuba, 21(6), 725-730. http://scielo.sld.cu/pdf/san/v21n6/san13216.pdf.

Eckstein, N., Haas, B., Hass, M. D. S., & Pfeifer, V. (2014). Systemic therapy of Cushing’s syndrome. Orphanet Journal of Rare Diseases, [S. l.], 9(122), 1-16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237936/pdf/s13023-014-0122-8.pdf.

Gámez, M. C., Alonso, E. D., González, M. M., Cedeño, A. A. & Tristá, S. E. T. (2021). Manifestaciones clínicas predictivas del diagnóstico del hipercortisolismo endógeno. Revista Cubana de Endocrinología, 32(1), e217.

Liberman, B. (2003). Papel da Terapia Medicamentosa na Síndrome de Cushing. Arquivos Brasileiros de Endocrinologia e Metabologia, São Paulo, 47(4), 381-387.

Machado, M. C., Fragoso, M. C. B. V., Moreira, A. C., Boguszewski, C. L., Vieira, L., Neto, Naves, L. A. ... & Ribeiro-Oliveira Júnior, A. (2016). Recommendations of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism for the diagnosis of Cushing’s disease in Brazil, Archives of Endocrinology and Metabolism, São Paulo, 60(3), 267-286. https://www.scielo.br/j/aem/a/bTHWQyQ4VJWmKBKg4Zz5q5b/?format=pdf&lang=en

Mathai, C., & Anolik, J. (2021). Cushing’s Disease as a Result of Two ACTH-Secreting Pituitary Tumors. AACE Clinical Case Reports, [S. l.], 7, 149-152,

Maurice, F., Gaborit, B., Vincentelli, C., Abdesselam, I., Bernard, M., Graillon, T. ... & Dutour, A. (2018). Cushing Syndrome Is Associated With Subclinical LV Dysfunction and Increased Epicardial Adipose Tissue. Journal of the American College of Cardiology, [S. l.], 72(18), 2276-2277.

Maya, L. F. F., González-Clavijo, A. M., Álvarez-Lozano, M. A., Moreno-Soler, G. A., Rodríguez-Paz, S. & Tarquino-Rincón, D. (2020). Exogenous Cushing´s syndrome with a difficult diagnosis. Acta Med Colomb., 45(3), 1-3.

Molina, P. E. (2021). Fisiologia Endócrina. Grupo A. https://integrada.minhabiblioteca.com.br/#/books/9786558040071/.

Nasser, V., Marchi, D. C. de, Oliveira, F. R. B. de, Machado, V., Póvoa, F. F., Bambig, M. T. N., & Póvoa, R. (2021). Doença de Cushing e hipertensão arterial: relato de caso. Rev Bras Hipertens., 28(1), 48-53.

Nieman, L. K. (2020). Establishing the diagnosis of Cushing's syndrome. 13 p. https://www.uptodate.com/contents/establishing-the-diagnosis-of-cushings-syndrome.

Pereira A. S. et al. (2018). Metodologia da pesquisa científica. [free e-book]. Santa Maria/RS. Ed. UAB/NTE/UFSM.

Rubinstein, G., Osswald, A., Hoster, E., Losa, M., Elenkova, A., Zacharieva, S. ... & Reincke, M. (2020). Time to Diagnosis in Cushing's Syndrome: A Meta-Analysis Based on 5367 Patients. Journal of Clinical Endocrinology & Metabolism, Washington, 105(3), e12-e23.

Tavares, F. R. S., Luz, E. R. da, Silva, C. E. G. da, Carvalho, J. M. L. de B., Sousa, A. P. de, & Ferreira, M. D. L. (2021). Efeitos deletérios do uso crônico de corticoides: uma abordagem do desenvolvimento da Síndrome de Cushing, Research, Society and Development, Vargem Grande Paulista – SP, 10(4), 1-13.

Velasco, L. de A., Crespo, L. R., Peres, D. T., Lemos Neto, M. de, & Teixeira, A. N. (2021). Síndrome de Cushing: uma revisão narrativa. Revista Científica da FMC, Campos dos Goytacazes - RJ, 16(1), 74-78.

Published

29/09/2022

How to Cite

MELO, I. M. .; DIAS, A. F.; AGUIAR, L. A. de; FIDELIS, B. C. A.; NUNES, M. R.; MACIEL, T. The challenge of clinical management of Cushing’s disease: case report . Research, Society and Development, [S. l.], v. 11, n. 13, p. e105111335218, 2022. DOI: 10.33448/rsd-v11i13.35218. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/35218. Acesso em: 25 nov. 2024.

Issue

Section

Health Sciences