Difficulties in the diagnosis of ACTH-dependent Cushing’s syndrome in a patient after left adrenalectomy and treated with glucocorticoids

Abstract

Cushing’s syndrome (CS), that is a consequence of chronic excess of corticosteroides, is most frequently of iatrogenic origin. Corticotropin secreting pituitary adenomas are responsible for most cases of endogenous Cushing’ s syndrome. Difficulties in the diagnosis and treatment of ACTH-dependent Cushing’s syndrome concern with localization of the source of pathological ACTH secretion, particularly when magnetic resonance imaging is unable to identify the pituitary microadenoma.
In this paper we present the case of a patient with symptoms of Cushing’s syndrome and describe problems with localization of the source of hypercortisolemia.The diagnostic process was additionally complicated by the treatment with corticosteroids, ocassionally applied due to concomitant diseases. This delayed the right diagnosis and treatment.