1. Case Conference 大林慈濟醫院新陳代謝科 郭錦松醫師

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

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

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

8. 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, 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.

9. 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

10. Laparascopic left adrenectomy

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

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

18. 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

19. Treatment
Adrenectomy
Cortisone replacement s/p operation

20. Thanks for your attention.