Cushing´s disease: Report of two cases and literature review

Solapas principales

Corredor A. 1, Valvuena S. 1, Chaves J. 1

 

ABSTRACT:

            First described in 1932, Cushing´s syndrome is a rare entity (I: 1.2-2.4 cases/million habitants/year), up to now not described in Colombia, that occurs as the result of chronic exposure to abnormally high levels of cortisol and other glucocorticoids. Its main cause is iatrogenic by exogenous administration of glucocorticoids, however, its main endogenous cause is an ACTH-secreting pituitary adenoma – Cushing´s disease (CD). Ideally, the treatment consists in surgical resection of the tumor leading to metabolic control and symptomatic resolution in most cases, however, others may require radiation as an adjuvant therapy to the surgical treatment to achieve remission of the disease. We present two case reports: the first one is an 18-years old female patient with two years of severe hypertension and progressive weight gain, in which extension studies revealed high levels of cortisol and a sellar mass. Transsphenoidal tumor resection was successfully performed. The second case is a 32-years old female patient with headache, morbid obesity, type II Diabetes Mellitus with poor glycaemic control, diagnosed with CD and treated in 2009 with resection of a ACTH-producer pituitary macroadenome which relapsed after 3 years, requiring a second curative intervention. Therefore, we can conclude CD is a rare and difficult diagnosis with a neurosurgical treatment and an excellent prognosis. It’s necessary for the general physician to recognize the classical symptoms of CD for an early diagnose and referral to the neurosurgeon.

Key Words:Cushing’s disease, pituitary ACTH hypersecretion, pituitary surgery, cortisol, obesity.

 

 

 

  1. Servicio de Neurocirugía Hospital El Tunal E.S.E. Universidad Nacional de Colombia

 

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