ABSTRACT
Cushing's syndrome results from prolonged exposure to high levels of glucocorticoid hormones. ACTH-dependent Cushing's syndrome accounts for about 85% of endogenous causes. Autonomous pituitary ACTH secretion, called Cushing's disease, is responsible for 80% of these causes, whereas ectopic ACTH secretion is responsible for 20% of them. Appropriate therapy of patients with Cushing's syndrome depends on accurate diagnosis and classification of the disorder. In addition to the history and clinical evaluation, the laboratory evaluation of a patient with Cushingoid appearance is necessary to establish the diagnosis and determine the cause of hypercortisolism. A major problem in the differential diagnosis of ACTH-dependent Cushing's syndrome is distinguishing Cushing's disease from the ectopic ACTH syndrome. Both entities can have similar clinical and laboratory features. In addition, both pituitary microadenoma and ectopic ACTH-secreting tumors may be radiologically occult. Bilateral inferior petrosal sinus and peripheral vein catheterization with simultaneous collection of samples for measurement of ACTH is one of the most specific tests available to localize the source of ACTH production. We report two cases of Cushing's syndrome diagnosed by inferior petrosal sinus sampling associated with normal or low ACTH levels on routine basal hormone assay.
Subject(s)
Humans , ACTH Syndrome, Ectopic , Adrenocorticotropic Hormone , Catheterization , Catheters , Classification , Cushing Syndrome , Diagnosis , Diagnosis, Differential , Petrosal Sinus Sampling , Plasma , VeinsABSTRACT
Myelodysplastic syndrome (MDS) is a hematologic disorder characterized by peripheral cytopenia and histologic feature of hematologic dysplasia. MDS has rarely been reported in association with Behcet's disease. We describe a patient with MDS associated Behcet's disease and a review of the literature.
Subject(s)
Humans , Myelodysplastic SyndromesABSTRACT
Peptic ulcer which extend beyond the serosa of the bowel wall may not perforate freely into the peritoneal cavity but instead penetrate adjacent structures (confined perforation). It has been reported that the frequency of penetration of peptic ulcer has been estimated around 20 percent in patients undergoing laparotomy for peptic ulcers. A 46-year- old male was admitted with chief complaint of hematemesis. Endoscopic examination revealed submucosal tumor like lesion with central ulcer and active bleeding which was located at the upper body, posterior wall of the stomach. Angiography demonstrated hypervascular tumor like lesion supplied by left gastric artery and short gastric branches of splenic artery. Postoperative biopsies showed inflammatory cell infiltration at the typical ulcer base and no evidence of malignancy. There was loss of acinus structure and fibrous adhesion with omentum at the pancreas. We report a case of gastric ulcer penetrating into pancreas, spleen with hypervascular nature with brief review of literatures.