Successful remission using metyrapone in an elderly patient with Cushing disease accompanied by generalized edema |
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Authors: | Motoko Ishikawa Takuma Narita Takehiro Sato Hiroshi Sasaki Takeshi Miura Tsukasa Morii Hiroki Fujta Yuichiro Yamada Masafumi Kakei |
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Institution: | Department of Internal Medicine, Division of Endocrinology Metabolism and Geriatric Medicine, Akita University School of Medicine, Akita, and;First Department of Medicine, Sitama Medical Center, Jichi Medical School of Medicine, Saitama, Japan |
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Abstract: | An 82-year-old woman was referred to our hospital because of hypoalbuminemia and generalized edema. Hypercortisolemia was subsequently found as the levels of serum cortisol and plasma adrenocorticotropic hormone (ACTH) sampled in a fasting morning were 140 pg/mL and 41.9 μg/dL, respectively. These hormones were not suppressed after taking low-dose dexamethasone the previous night and increased to a mild extent in response to administration of corticotrophin-releasing hormone, suggesting presence of pituitary adenoma producing ACTH (Cushing's disease). However, intrasella localization of pituitary adenoma could not be determined by magnetic resonance imaging. Soon after administration of metyrapone was started in an attempt to reduce her cortisol levels, the patient suffered from severe pneumonia. The pulmonary infection and peripheral edema were improved with decreases in cortisol levels by continuing metyrapone administration with antibiotics and finally she was discharged from the hospital on foot. Metyrapone is a useful therapeutic choice to achieve a remission of cortisol levels in the elderly patients with Cushing's disease in association with serious hypercortisolemia impending severe infection. |
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Keywords: | adrenocorticotropic hormone (ACTH) cortisol Cushing's disease elderly peripheral edema |
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