Accepted for publication 17 July 2014 Published 15 September 2014 Volume 20 Pages 1763—1767 DOI https://doi.org/10.2147/NDT.
S70611 Checked for plagiarism Yes Review by Single-blind Peer reviewer comments 3 Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan Abstract: Endogenous Cushing’s syndrome is an endocrine disease resulting from chronic exposure to excessive glucocorticoids produced in the adrenal cortex.
A 19-year-old Japanese male visited a local hospital following 5 days of behavioral abnormalities, such as money wasting or nighttime wandering.
Endocrinological testing showed adrenocorticotropic hormone-independent hypercortisolemia, and abdominal computed tomography demonstrated a 2.7 cm tumor in the left adrenal gland.
The patient underwent left adrenalectomy in September 2011, and the diagnosis of cortisol-secreting adenoma was confirmed histologically.
Following surgery, intravenous administration of hydrocortisone was initiated, and then oral hydrocortisone (20 mg/day) was maintained.
His peak plasma levels of ACTH and cortisol after intravenous corticotropin-releasing hormone (1 mg) were 5.2 pg/m L (at 30 minutes) and 0.3 μg/d L (at 60 minutes), respectively, under maintenance replacement therapy 2 weeks after surgery.
Laparoscopic left adrenalectomy was performed in September 2011.
Microscopic examination was consistent with a benign cortisol-secreting adrenocortical adenoma (Figure 3).In summary, the young age at onset and the short duration of Cushing’s syndrome probably contributed to the rapid recovery of both cognitive dysfunction and brain atrophy in our patient.Cushing’s syndrome should be considered as a possible etiological factor in patients with cognitive impairment and brain atrophy that is atypical for their age.Magnetic resonance imaging (MRI) revealed apparently diffuse brain atrophy.Because of high random plasma cortisol levels (28.7 µg/d L) at 10 AM, he was referred to our hospital in August 2011.Dilatation of ventricles, subarachnoid space, and sulci was also resolved, with an Evans’ index of 0.22.