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Phaeochromocytoma combined with subclinical Cushing's syndrome & pituitary microadenoma

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Phaeochromocytoma combined with subclinical Cushing's syndrome and pituitary microadenoma

 

GF Yaylali, F Akin, M Bastemir, YT Yaylali, and A Ozden

Clin Invest Med, January 1, 2008; 31(3): E176-81

Pamukkale University, School of Medicine, Department of Endocrinology and Metabolic Diseases, Denizli, Turkey. guzinf@gmail.com

 

OBJECTIVES: Phaeochromocytoma (PHEO) occasionally associates with pathological lesions of the adrenal cortex. The coexistence of PHEO and pre-clinical Cushing's syndrome (PCS) of the same adrenal gland has rarely been reported. We report a case of PHEO and PCS originating from the same adrenal gland and discuss the peculiar diagnostic aspects of this entity.

 

CLINICAL PRESENTATION: A 64 yr old man was hospitalized to evaluate the right adrenal mass which was discovered incidentally by ultrasonography. He had a history of type 2 diabetes mellitus and hyperlipidemia. Blood pressure measurements were all normal during his hospital stay. Laboratory examination showed: urinary catecholamines were markedly increased. HbA1C of 14.3 %, midnight cortisol of 11(microg/dL), cortisol was not suppressed after the overnight 1 mg oral dexamethasone suppression test (DST): 3.42(microg/dL), 24 hr free cortisol in the urine : 213 microg/day (10-100), cortisol levels were suppressed more than 50% with 8 mg of dexamethasone. CT scan of the adrenal glands showed a 6 cm well encapsulated right adrenal mass together with a clearly normal left adrenal gland. MRI investigation of the sella turcica revealed a pituitary microadenoma on the right side of the adenohypophysis He was treated with alpha and subsequent beta blockers after the diagnosis of PHEO and PCS was made. Right adrenalectomy was performed. The pathology showed typical PHEO with adrenocortical hyperplasia. VMA, metanefrin and free cortisol levels were normalized one month after surgery.

 

CONCLUSION: The present report is a rare case of PHEO combined with PCS in the same adrenal gland.

 

Publication Type:

 

* Journal article

 

PMID: 18544281

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Thanks Jane! I've always believed pheo's and cushings in one patient are more common than is thought.

love,

melly in nv

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Thank you!! I think this is exactly what's going on with my Mom. She's got 3 adrenal tumors, all 1-2 cm x 2cm. 2 on the right, 1 on the left adrenal.

 

She's been having wild spikes of BP that are like 250/130 and has started on her 2nd BP med but it's not doing much so far.

 

SHe also seems to have mild cushings numbers with her blood draws. She takes 3 meds at night to sleep which all reduce cortisol, yet her 8:00am levels are around 25, which I know are much lower than if she wasn't on those meds.

 

She's on medicare and I'm trying to figure out what things are covered and if there's a chance to take her outside of Indiana for treatment. I found a great nephrologist at the Cleveland Clinic who seems to be writing most of the current literature on pheo's plus he's Chairman of the 2nd Annual Pheo conference they're having this year.

 

Anyone else know if Medicare is able to be used outside of the state?

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I think the biggest disservice doctors do is assume that each disease/condition is acting in a vacuum or that because you have one condition you can't possibly have another. It's like assuming you're brakes can't be bad on your car because you need new headlights. Or as I'm learning...that if one thing goes wrong in your emissions system there's a huge and expensive cascade effect through the entire system and fixing one problem can unmask another problem.

 

I don't know the Medicare answer but I'd think since it's Federal there'd be some crossover? Anyone else with more knowledge that can chime in?

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This is precisely why it is soooo important to have a well-trained surgeon if you are contemplating a BLA, I think. For one, to make sure no adrenal rest tissue is present, and two, because I think pheos lurk more than we think they do!

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