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A ?smart? type of Cushing's syndrome


MaryO

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http://www.eje.org/cgi/content/abstract/157/6/779

 

DOI: 10.1530/EJE-07-0538

European Journal of Endocrinology, Vol 157, Issue 6, 779-781

Copyright ? 2007 by Society of the European Journal of Endocrinology

 

CASE REPORT

A ?smart? type of Cushing's syndrome

A J Razenberg, J W F Elte, A P Rietveld, H C T van Zaanen and M Castro Cabezas

 

Sint Franciscus Gasthuis Rotterdam, Department of Internal Medicine, Center for Diabetes and Vascular Medicine, PO Box 10900, 3004 BA Rotterdam, The Netherlands

 

(Correspondence should be addressed to M C Cabezas; Email: m.castrocabezas@sfg.nl)

 

Abstract

 

Cushing's syndrome results from lengthy and inappropriate exposure to excessive concentrations of either endogenous or exogenous glucocorticoids. This case report describes a patient with a novel type of Cushing's syndrome due to the use of party drugs. A 35-year-old woman had gained 8 kg body weight in 5 months and complained of anxiety. She showed a Cushing-like appearance and mild hypertension (blood pressure, BP 150/95 mmHg). She reported daily use of increasing doses of {gamma}-hydroxybutyric acid (GHB), a popular party drug. ACTH plasma levels were in the upper normal range (41 ng/l), with normal plasma cortisol (0.36 ?mol/l). She showed an abnormal overnight 1 mg dexamethasone suppression test (cortisol 0.38 ?mol/l). The urinary excretion of free cortisol in 24 h was also increased (0.47 ?mol/24 h). CT scanning of the abdomen showed normal adrenals. After stopping GHB intake she lost 7 kg body weight and her BP normalized (BP 135/80 mmHg). GHB is a popular party drug in the Netherlands, but it is also used as a narcotic and for the treatment of narcolepsy. We hypothesize that GHB may bind to the pituitary gland {gamma}-aminobutyric acid-B receptors leading to ACTH overproduction.

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I just don't understand what is "smart" about this.

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I totally agree. Not sure where smart fits in.

 

And, cushiemom, it corrected itself right away in that person's case so it is likely not your cause.

 

Nick

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