Summary
Disclosure: C.M. Godar: None. E.B. Noble: None. N.O. Vietor: None. T.S. Knee: None.
Background: Cushing’s syndrome might hardly ever current as an emergency often known as Florid Cushing’s Syndrome. Sufferers can exhibit extreme hyperglycemia, hypertension, hypokalemia, infections, and hypercoagulability. Cushing’s syndrome is a uncommon illness, and the constellation of medical options may be neglected if clinicians will not be conscious of the manifestations of hypercortisolism. We current the case of a affected person with Cushing’s syndrome that went unrecognized with life-threatening sequelae.
Case presentation: A 52-year-old lady with well-controlled sort 2 diabetes and hypertension was admitted to the hospital for extreme left decrease extremity cellulitis. Previous to hospitalization she had famous fast weight achieve, fatigue, weak spot, psychological clouding, and moodiness. She was admitted for antibiotics and surgical debridement. The an infection persevered regardless of broad spectrum antibiotics, a number of surgical debridements, and pores and skin grafting. She turned bacteremic, and extremity amputation was thought-about. She moreover developed hypertensive emergency, refractory hypokalemia, and hyperglycemia to 396 mg/dL. Examination was notable for facial plethora, supraclavicular fullness, dorsocervical fats pad, and violaceous stomach striae. Cushing’s Syndrome was suspected, and labs revealed a considerably elevated random serum cortisol of 60.5mcg/dL (Ref 6.2-19.4), considerably elevated 24H urine cortisol of 2157mcg/24H (Ref 0-50), and ACTH elevated to 81.8pg/mL (Ref 7.2-63.3) that confirmed Cushing’s Illness. MRI sella and octreotide scans didn’t localize a lesion. Inpatient remedy included a number of antihypertensive brokers, insulin drip, aggressive potassium repletion, and initiation of ketoconazole to cut back cortisol ranges. Ketoconazole was maximally dosed and he or she underwent surgical exploration and removing of a small pituitary microadenoma. Following surgical procedure, she developed transient adrenal insufficiency requiring hydrocortisone and he or she now not required antihypertensives, insulin, or potassium remedy. Comply with up 7 years later has revealed no recurrence of Cushing’s Illness.
Dialogue: Cushing’s Syndrome might current with quite a lot of medical options and infrequently might current as a medical emergency. Delay in prognosis can result in Florid Cushing’s Syndrome which carries excessive threat for morbidity and mortality. This case illustrates the necessity for clinician consciousness of the options of Cushing’s Syndrome: hypertension, hyperglycemia, fast weight achieve, cushingoid examination options, hypokalemia, hirsutism, virilization, an infection, and/or hypercoagulable state. Extreme hypercortisolism was chargeable for this affected person’s refractory an infection, and if not managed, she probably would have endured a decrease extremity amputation. Fast detection with elevated random serum and/or urine cortisol and remedy with a cortisol-lowering agent is vital and lifesaving.
Presentation: Thursday, June 15, 2023
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Filed below: Cushing’s, signs | Tagged: cellulitis, Cushing’s Illness, hypercoagulability., hypercortisolism, hyperglycemia, hypertension, hypokalemia, infections |