Cushing’s syndrome manifesting as chronic insomnia caused by adrenal cortical adenoma with incidental pituitary microadenoma: a case report

Background: Cushing’s syndrome is condition caused by excessive glucocorticoid with insomnia as one of its neuropsychiatric manifestation. Cushing’s syndrome may be caused by excessive adrenocorticotropin hormone (ACTH-dependent), for example from ACTH producing pituitary tumors, or by overproductio...

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Autores principales:	Rizky Rakhmayanti, Tania Tedjo Minuljo, Herlina Suryawati, Alifiati Fitrikasari, Mohamad Adi Soedarso, Dody Priambada
Formato:	article
Lenguaje:	EN
Publicado:	Diponegoro University 2021
Materias:	cushing’s syndrome insomnia adrenal cortical adenoma pituitary microadenoma dexamethasone suppression test Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/dee370b8e4a54d149cebc68071ec71ba
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spelling	oai:doaj.org-article:dee370b8e4a54d149cebc68071ec71ba2021-11-05T16:47:43ZCushing’s syndrome manifesting as chronic insomnia caused by adrenal cortical adenoma with incidental pituitary microadenoma: a case report2503-217810.14710/jbtr.v7i1.9247https://doaj.org/article/dee370b8e4a54d149cebc68071ec71ba2021-04-01T00:00:00Zhttps://ejournal2.undip.ac.id/index.php/jbtr/article/view/9247https://doaj.org/toc/2503-2178Background: Cushing’s syndrome is condition caused by excessive glucocorticoid with insomnia as one of its neuropsychiatric manifestation. Cushing’s syndrome may be caused by excessive adrenocorticotropin hormone (ACTH-dependent), for example from ACTH producing pituitary tumors, or by overproduction of cortisol by adrenocortical tumors. In this report, we presented a case with Cushing’s syndrome manifesting as chronic insomnia with adrenal cortical adenoma and pituitary microadenoma. Case presentation: A 30-year-old woman was consulted from the Neurologic Department to the Internal Medicine Department with the chief complaint of insomnia and worsening headache since 6 months prior to the admission. She had undergone head MRI and abdominal CT scan previously and was found to have both pituitary microadenoma and left adrenal mass. From the physical examination she had clinical signs of Cushing’s syndrome like Cushingoid face and purplish striae on her stomach. Midnight cortisol serum examination was done initially and showed high level of cortisol. High dose dexamethasone suppression test or DST (8 mg overnight) was later performed to help determine the main cause of Cushing’s syndrome. The result failed to reach 50% suppression of cortisol serum, suggestive that the Cushing’s syndrome was not ACTH-dependent from the pituitary but potentially from overproduction of cortisol by the left adrenal mass. Therefore, left adrenalectomy was performed and the histopathological study supported the diagnosis of adrenal cortical adenoma. Conclusion: Chronic insomnia is a very important symptoms of Cushing’s syndrome that should not be neglected. The patient had both microadenoma pituitary and left adrenal mass thus high dose DST test (8 mg overnight) needed to be performed to differentiate the source of Cushing’s syndrome. The result showed only little suppression therefore the pituitary microadenoma was not the source of Cushing’s syndrome and more suggestive from the adrenal etiology.Rizky RakhmayantiTania Tedjo MinuljoHerlina SuryawatiAlifiati FitrikasariMohamad Adi SoedarsoDody PriambadaDiponegoro Universityarticlecushing’s syndromeinsomniaadrenal cortical adenomapituitary microadenomadexamethasone suppression testMedicine (General)R5-920ENJournal of Biomedicine and Translational Research, Vol 7, Iss 1, Pp 22-26 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	cushing’s syndrome insomnia adrenal cortical adenoma pituitary microadenoma dexamethasone suppression test Medicine (General) R5-920
spellingShingle	cushing’s syndrome insomnia adrenal cortical adenoma pituitary microadenoma dexamethasone suppression test Medicine (General) R5-920 Rizky Rakhmayanti Tania Tedjo Minuljo Herlina Suryawati Alifiati Fitrikasari Mohamad Adi Soedarso Dody Priambada Cushing’s syndrome manifesting as chronic insomnia caused by adrenal cortical adenoma with incidental pituitary microadenoma: a case report
description	Background: Cushing’s syndrome is condition caused by excessive glucocorticoid with insomnia as one of its neuropsychiatric manifestation. Cushing’s syndrome may be caused by excessive adrenocorticotropin hormone (ACTH-dependent), for example from ACTH producing pituitary tumors, or by overproduction of cortisol by adrenocortical tumors. In this report, we presented a case with Cushing’s syndrome manifesting as chronic insomnia with adrenal cortical adenoma and pituitary microadenoma. Case presentation: A 30-year-old woman was consulted from the Neurologic Department to the Internal Medicine Department with the chief complaint of insomnia and worsening headache since 6 months prior to the admission. She had undergone head MRI and abdominal CT scan previously and was found to have both pituitary microadenoma and left adrenal mass. From the physical examination she had clinical signs of Cushing’s syndrome like Cushingoid face and purplish striae on her stomach. Midnight cortisol serum examination was done initially and showed high level of cortisol. High dose dexamethasone suppression test or DST (8 mg overnight) was later performed to help determine the main cause of Cushing’s syndrome. The result failed to reach 50% suppression of cortisol serum, suggestive that the Cushing’s syndrome was not ACTH-dependent from the pituitary but potentially from overproduction of cortisol by the left adrenal mass. Therefore, left adrenalectomy was performed and the histopathological study supported the diagnosis of adrenal cortical adenoma. Conclusion: Chronic insomnia is a very important symptoms of Cushing’s syndrome that should not be neglected. The patient had both microadenoma pituitary and left adrenal mass thus high dose DST test (8 mg overnight) needed to be performed to differentiate the source of Cushing’s syndrome. The result showed only little suppression therefore the pituitary microadenoma was not the source of Cushing’s syndrome and more suggestive from the adrenal etiology.
format	article
author	Rizky Rakhmayanti Tania Tedjo Minuljo Herlina Suryawati Alifiati Fitrikasari Mohamad Adi Soedarso Dody Priambada
author_facet	Rizky Rakhmayanti Tania Tedjo Minuljo Herlina Suryawati Alifiati Fitrikasari Mohamad Adi Soedarso Dody Priambada
author_sort	Rizky Rakhmayanti
title	Cushing’s syndrome manifesting as chronic insomnia caused by adrenal cortical adenoma with incidental pituitary microadenoma: a case report
title_short	Cushing’s syndrome manifesting as chronic insomnia caused by adrenal cortical adenoma with incidental pituitary microadenoma: a case report
title_full	Cushing’s syndrome manifesting as chronic insomnia caused by adrenal cortical adenoma with incidental pituitary microadenoma: a case report
title_fullStr	Cushing’s syndrome manifesting as chronic insomnia caused by adrenal cortical adenoma with incidental pituitary microadenoma: a case report
title_full_unstemmed	Cushing’s syndrome manifesting as chronic insomnia caused by adrenal cortical adenoma with incidental pituitary microadenoma: a case report
title_sort	cushing’s syndrome manifesting as chronic insomnia caused by adrenal cortical adenoma with incidental pituitary microadenoma: a case report
publisher	Diponegoro University
publishDate	2021
url	https://doaj.org/article/dee370b8e4a54d149cebc68071ec71ba
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Cushing’s syndrome manifesting as chronic insomnia caused by adrenal cortical adenoma with incidental pituitary microadenoma: a case report

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