Korean J Intern Med.  2008 Mar;23(1):49-52. 10.3904/kjim.2008.23.1.49.

A Case of Cushing's Syndrome Presenting as Endometrial Hyperplasia

• Lee SM
• Hahm JR
• Jung TS
• Jung JH
• Kang MY
• Kim SJ
• Chung SI

• KMID: 1382663
• DOI: http://doi.org/10.3904/kjim.2008.23.1.49

Abstract

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 microgram/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.

Keyword

Cushing syndrome; Endometrial hyperplasia; Metabolic syndrome X; Adrenocortical adenoma

MeSH Terms

Adrenal Cortex Neoplasms/complications/*diagnosis/surgery
Adrenalectomy
Adrenocortical Adenoma/complications/*diagnosis/surgery
Adrenocorticotropic Hormone/blood
Adult
Circadian Rhythm
Cushing Syndrome/*diagnosis/etiology/physiopathology
Diagnosis, Differential
Endometrial Hyperplasia/*diagnosis
Female
Humans
Hydrocortisone/secretion/urine