Hypogonadotropic Hypogonadism with Cushing's Disease-A Case
Introduction
Cushing’s disease is a rare endocrinal disorder with little epidemiological data available on the disease. It is estimated to affect 10-15 people per million population each year in United states and is listed in the Office of Rare Diseases of the National Institute of Health (NIH), last update d November 28, 2014 [1]. This girl presenting with amenorrhoea also had conspicuous cushingoid features. An ACTH secreting macroadenoma in the pituitary gland was picked up. A delay in the diagnosis could have led to serious morbidity, in terms of loss of vision as a result of pressure of the adenoma on the optic chiasma. Intracranial haemorrhage and organ failure too could have occurred because of severe hypertension. A hasty surgical resection not only prevented complications but also improved her reproductive function.

Case Report
A 27 year old girl presented on November 25, 2014, in the outpatient clinic with secondary amenorrhoea for the last 4-5 years. According to the patient she was not getting her periods when administered 5 day therapy, probably synthetic progestin. For the last 6 months she was having menstruation with cyclic oral contraceptive pills containing estradiol and norgestrel. She also reported aggravation of acne and increase in facial hair.

On examination, her height was 5 feet 3 inches and she weighed 70 kg; the body mass index was 32, suggestive of obesity. Her blood pressure was 170/110 mm. Acne pustules and pigmentation were seen on the face and facial hair was also increased (Figure 1A) marked hyperpigmentation was visible on the back as well (Figure 1B). The abdomen was broad, flabby with presence of striae and pigmented spots (Figure 1C).....

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