Preclinical Cushing's Syndrome Resulting from Adrenal Black Adenoma Diagnosed with Diabetic Ketoacidosis

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Author(s)

    • KAHARA TOSHIO
    • Department of Internal Medicine, Toyama Prefectural Central Hospital
    • UCHIYAMA AKIO
    • Department of Pathology, Toyama Prefectural Central Hospital
    • USUDA DAISUKE
    • Department of Internal Medicine, Toyama Prefectural Central Hospital
    • AKAHORI HIROSHI
    • Department of Internal Medicine, Toyama Prefectural Central Hospital
    • TAJIKA EIJI
    • Department of Urology, Toyama Prefectural Central Hospital
    • MIWA ATSUO
    • Department of Pathology, Toyama Prefectural Central Hospital
    • USUDA RIKA
    • Department of Internal Medicine, Toyama Prefectural Central Hospital

Abstract

A right adrenal tumor was incidentally discovered on abdominal computed tomography performed on a 53-year-old Japanese man, who had been hospitalized with diabetic ketoacidosis. Normal values were obtained for adrenal hormones in the morning after an overnight fast and urinary cortisol excretion after treatment of diabetic ketoacidosis with insulin. However, overnight dexamethasone administration with 1 mg or 8 mg did not completely suppress serum cortisol levels. There were no remarkable physical findings related to Cushing's syndrome. The patient was diagnosed as having preclinical Cushing's syndrome (PCS). Histological examination of the adrenalectomy specimen demonstrated adrenal black adenoma. Blood glucose levels subsequently improved after adrenalectomy, and the patient never developed adrenal insufficiency after hydrocortisone withdrawal. The patient was treated with diet therapy alone, and maintained good glycemic control. However, the patient still showed a diabetic pattern in an oral glucose tolerance test. It seems that the existence of PCS in addition to the underlying type 2 diabetes mellitus contributed to aggravation of blood glucose levels. Although there are many aspects of the natural course of PCS that have not been thoroughly elucidated, it is necessary to remain aware that a PCS patient with abnormal glucose metabolism may develop diabetic ketoacidosis by environmental agents.<br>

Journal

  • Endocrine Journal

    Endocrine Journal 54(4), 543-551, 2007-08-01

    The Japan Endocrine Society

References:  25

Cited by:  1

Codes

  • NII Article ID (NAID)
    10019809283
  • NII NACSIS-CAT ID (NCID)
    AA10901436
  • Text Lang
    ENG
  • Article Type
    Journal Article
  • ISSN
    09188959
  • Data Source
    CJP  CJPref  J-STAGE 
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