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Recurrent Cushing’s disease with low adrenal androgen production

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Abstract

A 33 year old woman presented with recurrent Cushing’s disease 4 years after complete remission induced by pituitary surgery. On relapse she exhibited the unusual pattern of elevated indices of Cortisol secretion with markedly suppressed serum DHEA-S; urinary 17-ketosteroid excretion was also below the normal range. Biochemical testing was otherwise consistent with ACTH-mediated hyper-cortisolism, and adrenal histopathology showed bilateral hyperplasia with no evidence of tumor. This case illustrates that serum DHEA-S is not an infallible guide to the differential diagnosis of Cushing’s syndrome, and it supports the existence of a pituitary-secreted adrenal androgen stimulating factor that is distinct from ACTH.

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Authors and Affiliations

  1. Department of Internal Medicine, Section of Endocrinology and Metabolism, Yale University School of Medicine, Fitkin 105, 333 Cedar Street, P.O. Box 3333, New Haven, CT, 06510, USA

    R. J. Louard & R. A. Gelfand

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  1. R. J. Louard
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  2. R. A. Gelfand
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Additional information

Dr Gelfand was supported by USPHS grant #DK 38578. and Dr. Louard by USPHS Training Grant #DK07476.

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Louard, R.J., Gelfand, R.A. Recurrent Cushing’s disease with low adrenal androgen production. J Endocrinol Invest 14, 965–969 (1991). https://doi.org/10.1007/BF03347123

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