Cyclic Cushing Syndrome, an Enigma in Diagnosis- A Case Report

Sharmin Jahan^1, , Hasanat MA¹, Md Enayet Hussain², Reazuddin Danesh¹, Nusrat Sultana¹, Mashfiqul Hasan¹ and Fariduddin M¹

¹Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh

²National Institute of Neurosciences (NINS), Agargaon, Dhaka, Bangladesh

Cite this paper:
Sharmin Jahan, Hasanat MA, Md Enayet Hussain, Reazuddin Danesh, Nusrat Sultana, Mashfiqul Hasan and Fariduddin M. Cyclic Cushing Syndrome, an Enigma in Diagnosis- A Case Report. American Journal of Medical Case Reports. 2016; 4(2):65-70. doi: 10.12691/ajmcr-4-2-9

Abstract

Cyclic Cushing syndrome is a rare disorder, characterized by repeated episodes of cortisol excess interspersed by periods of normal cortisol secretion. We report a 15-year-old boy with clinical Cushing syndrome and intermittent central Adrenocorticotropic hormone(ACTH) hypersecretion for a period of 8 years. Periods of hypercotisolemia as evidenced clinically and/or biochemically alternated with periods of eucortisolemia leading to much diagnostic dilemma. Ultimately, we were able to demonstrate the episodes of three peaks and two troughs of cortisol secretion favoring our diagnosis. His initial sellar MRI was negative, later high resolution dynamic sellar MRI unmasked a Pituitary micro-adenoma. In the absence of consensus for trans-sphenoidal adenomectomy (TSA) medical management in the form of sodium valproate was prescribed. At present he is on regular follow-up with marked clinical improvement.

Keywords:
Cyclic Cushing syndrome ACTH MRI negative Cushing disease

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