ABSTRACT
Coccidioidomycosis is caused by a dimorphous fungus, Coccidioides, which consists of two species, C. immitis and C. posadasii. Although these organisms are genetically distinct and do not exchange DNA, they appear identical phenotypically and the disease or immune response to the organisms is also identical. Coccidioides grows as a mycelium in the soil and is mainly found in Southwestern United States, northwestern Mexico, and Argentina. An infection usually results from inhaling the spores of the fungus in an endemic area. Patients with a localized infection and no risk factors for complications often require only a periodic reassessment to demonstrate the resolution of the self-limited process. However, patients with extensive spread of infection or high risk of complications as a result of immunosuppression or other preexisting factors require a variety of treatment strategies such as antifungal therapy, surgical debridement, or both. Korea is not endemic area of a coccidioidomycosis. We report a case of disseminated coccidioidomycosis involving the lung and skin, which was detected incidentally after sunburn in a 69 year-old Korean male with diabetes mellitus and iatrogenic Cushings syndrome, with a review of the relevant literature.
Subject(s)
Aged , Humans , Male , Argentina , Coccidioides , Coccidioidomycosis , Debridement , Diabetes Mellitus , DNA , Fungi , Immunosuppression Therapy , Inhalation , Korea , Lung , Mexico , Mycelium , Risk Factors , Skin , Soil , Southwestern United States , Spores , SunburnABSTRACT
We report herein the case of a 38-year-old woman with Cushings syndrome caused by bilateral adrenocortical adenomas. The adrenal tumor on the left side hypersecreted cortisol and no findings of cortisol hypersecretion from the adrenal tumor on the right side were observed on bilateral adrenal vein samplings. Both adrenal tumors were resected and histologically without any findings of nodular hyperplasia. The left adrenal tumor was histologically diagnosed as a so-called black adenoma. These data imply that the adrenal adenomas developed primarily from the adrenal gland itself, and that one of the tumors was well differentiated and secreted excess hormones, while the other remained in cell proliferation without hypersecretion.
Subject(s)
Adult , Female , Humans , Adenoma , Adrenal Glands , Adrenocortical Adenoma , Cell Proliferation , Cushing Syndrome , Hydrocortisone , Hyperplasia , VeinsABSTRACT
We experienced a case of Cushings syndrome due to adrenal adenoma associated with pregnancy 23th week in a 26 year old female patient. On physical findings, hypertension, moon face, hirsutism, abdominal striae and buffalo hump were noticed. Laboratory findings showed increased serum cortisol, increased 24 hours-urinary cortisol, and decreased plasma ACTH. Abdominal MRI demonstrated 4 cm sized in long diameter, well marginated, and ovoid-shape right adrenal mass. Unilateral total adrenalectomy was performed at the 23th week of pregnancy and the mass it was confirmed to benign adrenal adenoma. Steroid replacement therapy was continued with 7.5 mg prednisolone during remaining pregnancy. At the 38th week of pregnancy, labor was developed and she delivered healthy female weighing 2.5 kg through normal vaginal delivery without complication. Pregnancy rarely occurs in patients with Cushings syndrome. We think she was the first case in Korea who had normal 38th week transvaginal delivery after adrenalectomy in adrenal Cushings syndrome during pregnancy.
Subject(s)
Adult , Female , Humans , Pregnancy , Adenoma , Adrenalectomy , Adrenocorticotropic Hormone , Buffaloes , Cushing Syndrome , Hirsutism , Hydrocortisone , Hypertension , Korea , Magnetic Resonance Imaging , Plasma , PrednisoloneABSTRACT
OBJECTIVES: Microalbuminuria predicts cardiovascular mortality in patients with non-insulin-dependent diabetses mellitus (NIDDM). Microalbuminuria is frequently associated with high blood pressure, dyslipidemia, insulin resistance and central obesity, and has been suggested to be a feature of metabolic syndrome (syndrome X). Metabolic syndrome is also present in Cushings syndrome, which is characterized by primary hypercortisolism as well as profound visceral obesity. Considering common features of Cushings syndrome and metabolic syndrome, microalbuminuria could be a feature of Cushings syndrome. METHODS: We studied urinary albumin excretion (UAE) in 13 patients with Cushings syndrome. UAE was reexamined after the correction of hypercortisolemia in the patients with microalbuminuria or overt proteinuria. Kidney biopsy was performed in 3 patients with microalbuminuria. RESULTS: Eight out of 13 patients (61.5 %) had microalbuminuria. Kidney biopsy revealed apparently normal glomerular structures without evidence of diabetic or hypertensive nephropathy. Patients underwent successful removal of pituitary or adrenal tumors and were reevaluated 2 months after surgery. UAE declined profoundly in all of the patients with initial microalbuminuria. CONCLUSION: Our results demonstrate that more than 60% of patients with Cushings syndrome have microalbuminuria. This rate far exceeds the rate in NIDDM patients and hypertensive patients. Microalbuminuria nearly completely reversed after successful treatment of hypercortisolism.
Subject(s)
Humans , Biopsy , Cushing Syndrome , Diabetes Mellitus, Type 2 , Dyslipidemias , Hypertension , Insulin Resistance , Kidney , Mortality , Obesity, Abdominal , ProteinuriaABSTRACT
Cushings syndrome in pregnancy is rare. This is explained by the syndromes association with amencerhea, infertility and abortions. Matemal and fetal risks increase markedly when pregnancy does occur in woman with hypercortisolism. Since pregnant women without Cushings syndrome develop some features of Cushings syndrome, such as hypertension, hyperglycemia and striae, a high index of clinical suspician must be maintained to prevent delay in diagnosis. The physiologic changes in adrenocorticostemid metabolism during pregnancy further complieate the diagnosis. We describe a case of Cushings syndmme in pregnancy secondary to an adrenal cortical adenoma which was diagnosed immediately after a preterm delivery in 24-year-old woman with preeclampsia.
Subject(s)
Female , Humans , Pregnancy , Young Adult , Adenoma , Adrenocortical Adenoma , Cushing Syndrome , Diagnosis , Hyperglycemia , Hypertension , Infertility , Metabolism , Pre-Eclampsia , Pregnant WomenABSTRACT
Cushing's syndrome associated with nodular adrenal glands will be divided into four main categories: adrenal adenoma, adrenal carcinoma, primary pigmented nodular adrenal dysplasia (PPNAD) and macronodular adrenal hyperplasia(MAH). The term macronodular adrenal hyperplasia is restricted to the presence of multiple nodules visible to the naked eye, ranging in size from 0.5 to 7.0 cm. We report a case of Cushings syndrome caused by bilateral macronodular adrenal hyperplasia (MAH). A 45-year-old man presented with Cushingoid features, hypertension and diabetes mellitus. Urine free cortisol was 449.9 mmol/day(27-276) and were not suppressed after administration of low-dose and high-dose dexamethasone. Plasma ACTH was very low(1.87 pmol/L(18)) and was not stimulated by administration of ovine CRH. In abdominal CT, both adrenal glands were markedly enlarged and nodular in appearance. Pituitary MRI showed no abnormal finding. Bilateral adrenalectomy was done. Histologic examination revealed multiple nodules and internodular hyperplasia. This case and other reports suggested that because of variable biochemical, radiologic and pathologic findings, macronodular adrenal hyperplasia represents a heterogeneous group of patients with varying degrees of adrenal autonomy.
Subject(s)
Humans , Middle Aged , Adenoma , Adrenal Glands , Adrenalectomy , Adrenocorticotropic Hormone , Cushing Syndrome , Dexamethasone , Diabetes Mellitus , Hydrocortisone , Hyperplasia , Hypertension , Magnetic Resonance Imaging , Plasma , Tomography, X-Ray ComputedABSTRACT
The coexistence of adrenal cortical tumor and pheochromocytoma was extremely rare. A total of 25 reported cases showing evidence of hyperfuction of the adrenal cortex and pheochromocytoma were noted in the literature. Of those twenty cases were coexistence of pheochromocytoma and adrenocortical hyperplasia and only five cases were coincident pheochromocytoma and adreno-cortical adenoma. Recently, we experienced a case of adrenocortical adenoma associated with incidental pheochrmocytoma. A 55-year-old woman complained of progressive weight gain and epigastric discomfort. Hormonal and radiologic studies revealed Cushings syndrome with a left adrenal tumor. Adrenalectomy was performed and the gland actually had two nodules on its surface, one pheochromocytoma and the other cortical adenoma. This patient was the first case of pheochromocytoma with adrenocortical adenoma in Korea. We report the case with a review of literature.