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KMID : 0338420080230010049
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The Korean Journal of Internal Medicine
2008 Volume.23 No. 1 p.49 ~ p.52
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A Case of Cushing’s Syndrome Presenting as Endometrial Hyperplasia
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Lee Sang-Min
Hahm Jong-Ryeal
Jung Tae-Sik
Jung Jung-Hwa
Kang Mi-Yeon
Kim Sun-Joo
Chung Soon-Il
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Abstract
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We describe here the case of a 39-year-old woman with a cortisol-producing adrenal adenoma and she presented
with endometrial hyperplasia and hypertension without the specific characteristics of Cushing’s syndrome. The patient
had consulted a gynecologist for menometrorrhagia 2 years prior to her referral and she was diagnosed with
endometrial hyperplasia and hypertension. Her blood pressure and the endometrial lesion were refractory despite taking
multiple antihypertensives and repetitive dilation and curettage and progestin treatment. On admission, the clinical
examination revealed mild central obesity (a body mass index of 22.9 kg/m2, a waist circumference of 85 cm and a
hip circumference of 94cm), but there was no hirsutism and myopathy. She showed impaired glucose tolerance on an
oral glucose tolerance test. The biochemical hypercortisolemia together with the prolactin and androgen levels were
evaluated to explore the cause of her anovulation. Adrenal Cushing’s syndrome was confirmed on the basis of the
elevated urinary free cortisol (454 μg/24h, normal range: 20-70) with a suppressed ACTH level (2.0 pg/mL, normal
range: 6.0-76.0) and the loss of circadian cortisol secretion. A CT scan revealed a 3.1 cm, hyperechoic,
well-marginated mass in the left adrenal gland. Ten months post-adrenalectomy, the patient had unintentionally lost
9 kg of body weight, had regained a regular menstrual cycle and had normal thickness of her endometrium.
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KEYWORD
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Cushing syndrome, Endometrial hyperplasia, Metabolic syndrome X, Adrenocortical adenoma
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