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KMID : 0356620070220010062
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Journal of Korean Society of Endocrinology
2007 Volume.22 No. 1 p.62 ~ p.67
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A Case of Cushing’s Disease with Renal Cell Carcinomaand End-stage Renal Disease.
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Lee Jang-Eun
Choi Ik-Jun
Park Young-Jai
Lee Hyo-Jin
Lee Kyoung-Hwan
Ko Seung-Hyun
Song Ki-Ho
Ahn Yu-Bae
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Abstract
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Cushing’s disease is the most common cause of endogenous Cushing’s syndrome caused by the excessive secretion of adrenocorticotropic hormone (ACTH) by pituitary ACTH-secreting tumors. The tumors are usually microadenomas (< 10 mm in diameter). Macroadenomas are rare, and corticotroph hyperplasia and carcinomas are extremely rare. Patients with these tumors exhibit an increase in plasma ACTH and cortisol levels, elevated urinary excretion of cortisol and adrenocortical steroid metabolites, evidence of altered negative feedback of cortisol and disturbances in neuroendocrine regulation. The diagnosis of Cushing’s disease can be challenging in patients with renal failure the presence of abnormal plasma cortisol, poor gastrointestinal tract absorption of dexamethasone and altered functioning of the hypophyseal-pituitary-adrenal axis have been reported in end-stage renal disease, and the urinary cortisol increment method is not reliable in these patients. The prevalence of renal cell carcinoma in patients on dialysis is higher than in the general population. We recently treated a patient with Cushing’s disease and end-stage renal disease as a result of renal cell carcinoma. The diagnosis was made by laboratory evaluation of plasma and radiological examination. Here we report a case of Cushing’s disease with a review of the medical literature.
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KEYWORD
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Cushing’s disease, End-stage renal disease, Renal cell carcinoma
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