Case report: Pheochromocytoma-induced pseudo-Cushing’s syndrome
Non-neoplastic hypercortisolaemia, also known as pseudo-Cushing’s syndrome (PCS), is a physiological overactivation of the hypothalamic–pituitary–adrenal axis that can be triggered by conditions such as depression, eating disorders, extreme exercise, obesity, alcoholism, poorly controlled diabetes,...
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Frontiers Media S.A.
2024-12-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2024.1491873/full |
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| author | Małgorzata Bobrowicz Anna Nagórska Anna Karpiłowska Marek Rosłon Joanna Hubska Joanna Hubska Adrianna Gładka Sadegh Toutounchi Łukasz Koperski Urszula Ambroziak |
| author_facet | Małgorzata Bobrowicz Anna Nagórska Anna Karpiłowska Marek Rosłon Joanna Hubska Joanna Hubska Adrianna Gładka Sadegh Toutounchi Łukasz Koperski Urszula Ambroziak |
| author_sort | Małgorzata Bobrowicz |
| collection | DOAJ |
| description | Non-neoplastic hypercortisolaemia, also known as pseudo-Cushing’s syndrome (PCS), is a physiological overactivation of the hypothalamic–pituitary–adrenal axis that can be triggered by conditions such as depression, eating disorders, extreme exercise, obesity, alcoholism, poorly controlled diabetes, chronic kidney disease, and cachexia. Here, we describe an unusual case of pheochromocytoma-induced PCS. A 66-year-old woman was referred to the hospital due to pronounced weakness, loss of appetite, apathy, weight loss, newly diagnosed diabetes mellitus, and poorly controlled hypertension. The biochemical evaluation suggested ACTH-dependent hypercortisolemia with severe hypokalemia, metabolic alkalosis, and hyperglycemia. Markedly elevated levels of metanephrines, along with imaging showing a heterogeneous adrenal lesion, provided evidence for pheochromocytoma. Considering the clinical features and the results of laboratory and imaging tests, there was a suspicion of hypercortisolemia due to ectopic ACTH secretion by a pheochromocytoma. The patient underwent adrenalectomy following pre-treatment with doxazosin and metyrapone, enteral feeding, protein supplementation, and insulin administration. Post-surgery, the patient did not require further antidiabetic medication, experienced gradual weight gain, improved well-being, and did not need glucocorticoid supplementation. Histopathological examination confirmed a pheochromocytoma; however, both anti-ACTH and anti-CRH stainings were negative, leading to a diagnosis of PCS. This case highlights the distinctive presentation of PCS caused by pheochromocytoma, as demonstrated through clinical, laboratory, and histopathological findings, and emphasizes the successful resolution achieved through adrenalectomy and supportive care. |
| format | Article |
| id | doaj-art-219c951f245c4a2ab35149465792f4d1 |
| institution | DOAJ |
| issn | 1664-2392 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj-art-219c951f245c4a2ab35149465792f4d12025-08-20T03:21:32ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922024-12-011510.3389/fendo.2024.14918731491873Case report: Pheochromocytoma-induced pseudo-Cushing’s syndromeMałgorzata Bobrowicz0Anna Nagórska1Anna Karpiłowska2Marek Rosłon3Joanna Hubska4Joanna Hubska5Adrianna Gładka6Sadegh Toutounchi7Łukasz Koperski8Urszula Ambroziak9Department of Internal Medicine and Endocrinology, University Clinical Centre of the Medical University of Warsaw, Warsaw, PolandDepartment of Internal Medicine and Endocrinology, University Clinical Centre of the Medical University of Warsaw, Warsaw, PolandDepartment of Internal Medicine and Endocrinology, University Clinical Centre of the Medical University of Warsaw, Warsaw, PolandDepartment of Internal Medicine and Endocrinology, University Clinical Centre of the Medical University of Warsaw, Warsaw, PolandDepartment of Internal Medicine and Endocrinology, University Clinical Centre of the Medical University of Warsaw, Warsaw, PolandDoctoral School of Medical University of Warsaw, Warsaw, PolandDepartment of Internal Medicine and Endocrinology, University Clinical Centre of the Medical University of Warsaw, Warsaw, PolandDepartment of General, Endocrine, and Vascular Surgery, Medical University of Warsaw, Warsaw, PolandDepartment of Pathology, Medical University of Warsaw, Warsaw, PolandDepartment of Internal Medicine and Endocrinology, University Clinical Centre of the Medical University of Warsaw, Warsaw, PolandNon-neoplastic hypercortisolaemia, also known as pseudo-Cushing’s syndrome (PCS), is a physiological overactivation of the hypothalamic–pituitary–adrenal axis that can be triggered by conditions such as depression, eating disorders, extreme exercise, obesity, alcoholism, poorly controlled diabetes, chronic kidney disease, and cachexia. Here, we describe an unusual case of pheochromocytoma-induced PCS. A 66-year-old woman was referred to the hospital due to pronounced weakness, loss of appetite, apathy, weight loss, newly diagnosed diabetes mellitus, and poorly controlled hypertension. The biochemical evaluation suggested ACTH-dependent hypercortisolemia with severe hypokalemia, metabolic alkalosis, and hyperglycemia. Markedly elevated levels of metanephrines, along with imaging showing a heterogeneous adrenal lesion, provided evidence for pheochromocytoma. Considering the clinical features and the results of laboratory and imaging tests, there was a suspicion of hypercortisolemia due to ectopic ACTH secretion by a pheochromocytoma. The patient underwent adrenalectomy following pre-treatment with doxazosin and metyrapone, enteral feeding, protein supplementation, and insulin administration. Post-surgery, the patient did not require further antidiabetic medication, experienced gradual weight gain, improved well-being, and did not need glucocorticoid supplementation. Histopathological examination confirmed a pheochromocytoma; however, both anti-ACTH and anti-CRH stainings were negative, leading to a diagnosis of PCS. This case highlights the distinctive presentation of PCS caused by pheochromocytoma, as demonstrated through clinical, laboratory, and histopathological findings, and emphasizes the successful resolution achieved through adrenalectomy and supportive care.https://www.frontiersin.org/articles/10.3389/fendo.2024.1491873/fullpseudo-Cushing’s syndromeectopic ACTH secretionhypercortisolaemiapheochromocytomacachexia |
| spellingShingle | Małgorzata Bobrowicz Anna Nagórska Anna Karpiłowska Marek Rosłon Joanna Hubska Joanna Hubska Adrianna Gładka Sadegh Toutounchi Łukasz Koperski Urszula Ambroziak Case report: Pheochromocytoma-induced pseudo-Cushing’s syndrome Frontiers in Endocrinology pseudo-Cushing’s syndrome ectopic ACTH secretion hypercortisolaemia pheochromocytoma cachexia |
| title | Case report: Pheochromocytoma-induced pseudo-Cushing’s syndrome |
| title_full | Case report: Pheochromocytoma-induced pseudo-Cushing’s syndrome |
| title_fullStr | Case report: Pheochromocytoma-induced pseudo-Cushing’s syndrome |
| title_full_unstemmed | Case report: Pheochromocytoma-induced pseudo-Cushing’s syndrome |
| title_short | Case report: Pheochromocytoma-induced pseudo-Cushing’s syndrome |
| title_sort | case report pheochromocytoma induced pseudo cushing s syndrome |
| topic | pseudo-Cushing’s syndrome ectopic ACTH secretion hypercortisolaemia pheochromocytoma cachexia |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2024.1491873/full |
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