A CASE OF CUSHING'S SYNDROME ASSOCIATED WITH ISOLATED ADRENOCORTICOTROPIN (ACTH) DEFICIENCY AFTER THE REMOVAL OF CORTISOL-PRODUCING ADRENAL ADENOMA

Abstract

A 45-yr-old woman with Cushing's syndrome who could not be withdrawn from postoperative hydrocortisone supplement for over 3 years after the removal of an adrenocortical adenoma is presented. This was diagnosed as associating with isolated ACTH deficiency. She had suffered from persistent severe general fatigure since 5 years prior. However, after 2 years, obesity, hypertension and moon face developed, while the malaise improved. She was then diagnosed as having Cushing's syndrome and underwent the extirpation of right adrenal adenoma. The dosage of supplementary hydrocortisone was gradually reduced after surgery. However the hydrocortisone dose could not be reduced lower than 10mg/day after several trials of dose reduction as severe general fatigue would ensue. The pituitary function tests at postoperative 2 years and a half-year, revealed an association of isolated ACTH deficiency. It was unknown whether the isolated ACTH deficiency arose before or after the surgery. In the present report, we discuss the association of isolated ACTH deficiency and Cushing's. syndrome.