Case Conference 大林慈濟醫院新陳代謝科 郭錦松醫師

Chief Complaint Amenorrhea for 6 months and weight gain (Feb, 2001) 36 y/o female 158cm, 58kg (weight gain from 52kg to 58kg)

Physical exams Moon face (+), supraclavicular pad (+), buffalo hump (-), acne (+), striaes (-) Goiter (-)

Course 1 Oct 2000. Irregular menstrual cycle, edema (+) Feb 2001. Puffy face, no menstrual cycle for 6 months. Normal thyroid functional tests, cortisol 8am =21.0 ug/dl (4.3-22.4), and prolactin level=20.7 ng/ml (male, 2.1-17.7; female, 2.8-29)

Course 2 Aug 2002: T3=112.7 ng/dl, T4=6.2 ug/dl, TSH=1.038 uIU/ml, cortisol=19.8 ug/dl Sep 12, 2002. CT of abdomen: left adrenal tumor, 2.5x2.5cm well-defined hypodense mass with homogenous well enhancement OPD: low dose and high dose dexamethasone suppression test showed compatible with adrenal Cushing syndrome>> arrange operation on Feb 5th, 2003.

Functional tests 24-hr urine free cortisol=600ug/d (<100ug) Low-dose dexamethasone suppression test: cortisol level=18.4 ug/dl: High-dose dexamethasone suppression test: cortisol level=20.2 ug/dl Cortisol 4pm=21.8 ug/dl

Laparascopic left adrenectomy

Cushing's syndrome Cushing's disease adrenal Cushing Iatrogenic Cushing's syndrome Ectopic ACTH syndrome

Adrenal Cushing's syndrome Incidence: 1-2/million per year Female > male Most of them are benign

Diagnosis 24-h urine free cortisol level 1-mg dexamethasone test Low-dose dexamethasone test High-dose dexamethasone test Midnight serum or saliva cortisol level ACTH level

Treatment Adrenectomy Cortisone replacement s/p operation

Thanks for your attention.