Subclinical Cushing's Disease Accompanied by Malignant Hypertension and Diabetes Mellitus.

Abstract

A 53-year-old woman was admitted because of hypertension and diabetes inellitus. Elevated diastolic blood pressure, hypertensive retinopathy and renal dysfunction indicated malignant hypertension. Adrenocorticotropic hormone (ACTH)and cortisol levels were high although there were no Cushingoid features.One mgdexamethasone administration decreased neither ACTHnor cortisol levels. Brain magnetic resonance imaging revealed a left pituitary tumor (7 mmx 6 mm).Uponremoval, the tumor showed positive ACTHstaining by immnohistochemistry, and was diagnosed as pituitary ACTH-secreting adenoma (Cushing's disease). Her blood pressure, renal function, blood glucose and hormone levels subsequently improved. Malignant hypertension and deteriorated diabetes mellitus mayhave been due to subclinical Cushing's disease. (Intrenal Medicine 41: 566-570, 2002)

Pathophysiology and treatment of subclinical Cushing’s disease and pituitary silent corticotroph adenomas [Review]

“…In Sakai et al's case, transsphenoidal resection of pituitary adenoma was performed, and immunohistochemistry revealed an ACTH-producing tumor. Further cases of subclinical or preclinical Cushing's disease have been reported in the English literature [20,21].…”

“…Degree of excess cortisol production may be associated with the typical Cushingoid appearance. However, there are some reports that subclinical Cushing's disease may be associated with metabolic change [21,27]. It is possible that mild hypercortisolism due to autonomous secretion of ACTH contributes to the metabolic change in subclinical Cushing's disease.…”

“…Nagai et al [21] reported improved blood pressure and glucose levels after resection of pituitary adenoma, even in cases of subclinical Cushing's disease. For instance, before the operation, blood pressure was uncontrolled under treatment with furosemide, nifedipine, doxazosin mesilate, and cilazapril, and the fasting blood glucose level was 241 mg/dL, and HbA1c level was 11.0%.…”

The Frequency of Type 2 Diabetic Patients who Meet the Endocrinological Screening Criteria of Subclinical Cushing's Disease

“…The first report consistent with subCD was published in 1987 [8]. in Japan, subCD was first reported in 1994 [9], and several reports followed [2,10,11,12]. Hypertension and hyperglycemia ameliorated after the resection of pituitary adenoma in some cases.…”

Subclinical Cushings Disease with Amelioration of Metabolic Comorbidities after Removal of Pituitary Tumor

“…On the other hand, only a few cases of ACTH-secreting pituitary adenomas without a Cushingoid feature termed subclinical/preclinical Cushing's disease, have been reported to date (3)(4)(5) …”