Rapid Control Of Ectopic Cushing’s Syndrome During The Covid-19 Pandemic in a Patient With Chronic Hypokalaemia

Posted on May 25, 2021 by MaryO

This article was originally published here

Endocrinol Diabetes Metab Case Rep. 2021 May 1;2021:EDM210038. doi: 10.1530/EDM-21-0038. Online ahead of print.

ABSTRACT

SUMMARY: In this case report, we describe the management of a patient who was admitted with an ectopic ACTH syndrome during the COVID pandemic with new-onset type 2 diabetes, neutrophilia and unexplained hypokalaemia. These three findings when combined should alert physicians to the potential presence of Cushing’s syndrome (CS). On admission, a quick diagnosis of CS was made based on clinical and biochemical features and the patient was treated urgently using high dose oral metyrapone thus allowing delays in surgery and rapidly improving the patient’s clinical condition. This resulted in the treatment of hyperglycaemia, hypokalaemia and hypertension reducing cardiovascular risk and likely risk for infection. Observing COVID-19 pandemic international guidelines to treat patients with CS has shown to be effective and offers endocrinologists an option to manage these patients adequately in difficult times.

LEARNING POINTS: This case report highlights the importance of having a low threshold for suspicion and investigation for Cushing’s syndrome in a patient with neutrophilia and hypokalaemia, recently diagnosed with type 2 diabetes especially in someone with catabolic features of the disease irrespective of losing weight. It also supports the use of alternative methods of approaching the diagnosis and treatment of Cushing’s syndrome during a pandemic as indicated by international protocols designed specifically for managing this condition during Covid-19.

PMID:34013889 | DOI:10.1530/EDM-21-0038

From https://www.docwirenews.com/abstracts/rapid-control-of-ectopic-cushings-syndrome-during-the-covid-19-pandemic-in-a-patient-with-chronic-hypokalaemia/

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Severe Infection Including Disseminated Herpes Zoster Triggered by Subclinical Cushing’s Disease

Posted on May 18, 2021 by MaryO

Abstract

Background

Subclinical Cushing’s disease (SCD) is defined by corticotroph adenoma-induced mild hypercortisolism without typical physical features of Cushing’s disease. Infection is an important complication associated with mortality in Cushing’s disease, while no reports on infection in SCD are available. To make clinicians aware of the risk of infection in SCD, we report a case of SCD with disseminated herpes zoster (DHZ) with the mortal outcome.

Case presentation

An 83-year-old Japanese woman was diagnosed with SCD, treated with cabergoline in the outpatient. She was hospitalized for acute pyelonephritis, and her fever gradually resolved with antibiotics. However, herpes zoster appeared on her chest, and the eruptions rapidly spread over the body. She suddenly went into cardiopulmonary arrest and died. Autopsy demonstrated adrenocorticotropic hormone-positive pituitary adenoma, renal abscess, and DHZ.

Conclusions

As immunosuppression caused by SCD may be one of the triggers of severe infection, the patients with SCD should be assessed not only for the metabolic but also for the immunodeficient status.

Read the rest of the article at https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-021-00757-y

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FDA accepts NDA for novel Cushing’s syndrome treatment

Posted on May 17, 2021 by MaryO

The FDA accepted for review a new drug application for the steroidogenesis inhibitor levoketoconazole for the treatment of  endogenous Cushing’s syndrome , according to an industry press release.

“We are pleased with the FDA’s acceptance for filing of the Recorlev new drug application,” John H. Johnson, CEO of Strongbridge Biopharma, said in the release. “We believe this decision reflects the comprehensive clinical evidence that went into the NDA submission, including the positive and statistically significant efficacy and safety results from the multinational phase 3 SONICS and LOGICS studies evaluating Recorlev as a potential treatment option for adults with endogenous Cushing’s syndrome. We are advancing our commercial readiness plans and look forward to potentially bringing a new therapeutic option to the Cushing’s syndrome community in the first quarter of 2022.”

As Healio previously reported, top-line findings from the LOGICS study demonstrated that levoketoconazole (Recorlev, Strongbridge Biopharma) improved and normalized morning urinary free cortisol concentrations for adults with endogenous Cushing’s disease compared with placebo.

The drug was generally well tolerated, with safety data mirroring those from the earlier phase 3 SONICS trial.

Endogenous Cushing’s syndrome — caused by chronic hypercortisolism — is rare, with estimates ranging from 40 to 70 people per million affected worldwide, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

The FDA set a Prescription Drug User Fee Act target action date of Jan. 1, 2022, for levoketoconazole, according to the company. The FDA letter made no mention of a plan to hold an advisory committee meeting.

From https://www.healio.com/news/endocrinology/20210513/fda-accepts-nda-for-novel-cushings-syndrome-treatment

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Acromegaly: Chronic disease root of young man’s abnormally gray hair and facial changes

Posted on May 10, 2021 by MaryO

A chronic, progressive disease was discovered to be the reason why a man in his 20s experienced a sudden increase of gray hair and facial changes, local doctors said.

The man recently went to Renji Hospital to find out why the changes had taken place.

Doctors suspected he suffered from acromegaly, a chronic disease characterized by enlargement of head bones, soft parts of the feet and hands and sometimes other parts of the body due to excessive secretion of growth hormones by the pituitary gland.

Doctors conducted an MRI and found a pituitary tumor, which caused the man’s acromegaly. To their surprise, doctors also found a cyst in his brain.

Doctors conducted one successful surgery to treat both problems simultaneously.

Dr Ma Jing, director of Renji Hospital’s endocrinology department, said acromegaly is an endocrine metabolism disease that has no symptoms in its early stages, and most people are not diagnosed with it until they are 40 or 50, commonly 4.5 to 9 years after originally contracting the disease — in some extreme cases, 20 years later.

In addition to affecting the hands, feet and face, the disease can afflict the cardiovascular system, causing problems like hypertension and poor heart function. Those with the disease also have a higher risk of diabetes, thyroid and intestinal tumors, Ma said.

“Since people with acromegaly usually have abnormal endocrine function, early screening and diagnosis is important,” she said.

From https://www.shine.cn/news/metro/2105078537/

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Chronic Insomnia Can Be Sign of Cushing’s

Posted on May 9, 2021 by MaryO

Abstract

Background: Cushing’s syndrome is a condition caused by excessive glucocorticoid with insomnia as one of its neuropsychiatric manifestation. Cushing’s syndrome may be caused by excessive adrenocorticotropin hormone (ACTH-dependent), for example from ACTH producing pituitary tumors, or by overproduction of cortisol by adrenocortical tumors. In this report, we presented a case with Cushing’s syndrome manifesting as chronic insomnia with adrenal cortical adenoma and pituitary microadenoma.

Case presentation: A 30-year-old woman was consulted from the Neurologic Department to the Internal Medicine Department with the chief complaint of insomnia and worsening headache for 6 months prior to the admission. She had undergone head MRI and abdominal CT scan previously and was found to have both pituitary microadenoma and left adrenal mass. From the physical examination she had clinical signs of Cushing’s syndrome like Cushingoid face and purplish striae on her stomach. Midnight cortisol serum examination was done initially and showed high level of cortisol. High dose dexamethasone suppression test or DST (8 mg overnight) was later performed to help determine the main cause of Cushing’s syndrome. The result failed to reach 50% suppression of cortisol serum, suggestive that the Cushing’s syndrome was not ACTH-dependent from the pituitary but potentially from overproduction of cortisol by the left adrenal mass. Therefore, left adrenalectomy was performed and the histopathological study supported the diagnosis of adrenal cortical adenoma.

Conclusion: Chronic insomnia is a very important symptoms of Cushing’s syndrome that should not be neglected. The patient had both microadenoma pituitary and left adrenal mass thus high dose DST test (8 mg overnight) needed to be performed to differentiate the source of Cushing’s syndrome. The result showed only little suppression therefore the pituitary microadenoma was not the source of Cushing’s syndrome and more suggestive from the adrenal etiology.

Keywords: Cushing’s syndrome; insomnia; adrenal cortical adenoma; pituitary microadenoma; dexamethasone suppression test

Permalink/DOI: https://doi.org/10.14710/jbtr.v7i1.9247I

Read the entire article here: https://ejournal2.undip.ac.id/index.php/jbtr/article/view/9247/5440

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