Prolonged childhood Cushing syndrome secondary to intralesional triamcinolone acetonide

Intralesional corticosteroids have been used in the treatment of hypertrophic keloid scars for over 40 years. The few complications documented have mostly been local skin changes, viz depigmentation and cutaneous atrophy. Cushing's syndrome following intralesional injection is rare and usually self-limiting following cessation of therapy. This report describes a 9-year-old girl who developed Cushing's syndrome 2-3 weeks after a single treatment with 40 mg triamcinolone acetonide injected into keloids. Features of Cushing's syndrome and a suppressed hypothalamic-pituitary axis were present up to 9 months later. Three years after glucocorticoid injections, features of Cushing's syndrome had largely disappeared. Dosages of intralesional steroids normally recommended for adults are inappropriate for children.

A clinico-pathological study of Cushing's syndrome at the University Hospital of the West Indies and a review of literature

Cushing's syndrome is an uncommon but important disease. Twenty-one confirmed cases of spontaneous Cuching's syndrome were documented at the University Hospital of the West Indies over a 21-year period. They were predominantly young females (F:M ratio of 17:4; mean age 25 years and three months). The commonest presenting symptoms were amenorrhoea (41 percent) and obesity (19 percent). Common clinical features were cushingnoid features (95 percent), hypertension (76 percent) and hirsutism (82 percent). Twenty-nine per cent had frank hyperglycaemia. Cushing's syndrome was due to Cushing's disease in 10 cases, adrenal adenoma in 3 and adrenal carcinoma in 2 cases. In 4 cases with presumed adrenal hyperplasia, the histology was either unavailable or was not consistent with the diagnosis. Two cases appear now to have had ectopic ACTH syndrome. Adrenalectomy was the commonest treatment offered. There were no intra-operative or post-operative deaths but recurrence was common after subtotal adrenalectomy in Cushing's disease. Twenty-seven per cent of the patients developed Nelson's syndrome, which was fatal in 50 per cent. Long-term hormone replacement therapy was unnecessary after surgery for adrenal adenomas. Treatment of Cushing's syndrome was well tolerated by the patients. (AU)

The ectopic ACTH Syndrome and superior vena cava obstruction due to a malignant carcinoid tumour of the thymus

We report the case of a 28-year-old African Caribbean woman with Cushing's syndrome and superior vena cava obstruction secondary to an ACTH-secreting carcinoid tumour of the thymus. The case highlights the problems which may be encountered in performing the 2-day high dose dexamethasone suppression test but clinicians are reminded that this test or any other dynamic test is absolutely essential for elucidating the cause of ACTH-dependent Cushing's Syndrome (AU)

Recurrence of endogenous cortisol secretion after bilateral total adrenalectomy: 2 cases

Bilateral total adrenalectomy is a common treatment for Cushing's Syndrome in underdeveloped countries where limited resources restrict the use of extensive investigations, where the source of ACTH secretion is not identified or where neurosurgical facilities are minimal. Two cases of recurrence of cortisol secretion managed at the University Hospital of the West Indies are presented. The aetiology is discussed. (AU)

Cushing's syndrome from tropical glucocorticoids

A case of Cushing's syndrome is described in a woman who self-treated psoriasis with a variety of potent tropical glucocorticoids over 15 years. She was successfully weaned off corticosteroids and was treated with alternative anti-psoriatic drugs. The disappearance, nine months later, of most features of Cushing"s syndrome, and the normal supression of cortisol in response to dexamethasone, excluded endogenous hypercorticolism. The apparent widespread availability across the counter of potent corticosteriods is a cause of concern. (AU)

Cushing's syndrome and its differential at the University Hospital of the West Indies - abstract

Crushing's syndrome is a rare condition with a potential for morbidity and mortality. During a 20-year retrospective review of patients with the diagnosis confirmed at the University Hospital, 20 cases were seen. There were 5 men and 15 women with an age range of 15 to 60 years and a mean age of 27 years. Sixty per cent of cases were due to hyperplasia, 15 percent to adenoma, 10 percent to carcinoma and 5 percent(1 case) was of ectopic origin in a patient with bronchogenic carcinoma. The zona fasciculata was involved in 90 percent of cases of hyperplasia. The clinical features of these black patients were as described elsewhere but we noted hypopigmentation alone in 45 percent of patients, with hyperpigmentation in 33 percent. One female patient, age 38, had a 13-year history of hypertension and later developed psychiatric symptoms. A 30-year-old man, who had severe hypertension of recent onset, developed congestive cardiac failure, and an adenoma compressing the renal artery was found at laparotomy. Difficult to control diabetes mellitus in a 27-year-old female was followed 3 years later by the development of cushionoid features. The mean time interval between the onset ofsymptoms and the confirmation of the diagnosis was 2 years 8 months. Serum cortisol levels with loss of diurnal variation and the dexamethasone suppression tests are still quite useful in confirming the diagnosis. Urinary cortisol and serum ACTH levels are not available here. Venography is the commonest and better-used method for localisation. Ultrasonography recently available has so far not been found to be helpful. Sixteen patients underwent successful surgery; two were scheduled for surgery, and one refused. Three patients developed Nelson's syndrome 1 to 4 years after surgery and two of them died, one in the perioperative period after transphenoidal resection of the pituitary tumor. Twenty-seven patients investigated for cushing's Syndrome during the same study period showed the cause to be simple obesity in 21 and Stein-Leventhal Syndrome in 6. It is concluded that blacks in Jamaica with cushing's syndrome present with similar clinical features as elsewhere, except for hypopigmented skin lesions. The zona fasciculata site involved. The serum cortisol and dexamethasone suppression tests are satisfactory in establishing a diagnosis (AU)

Cushing's syndrome

The etiology and management of this syndrome were reviewed and a case reported of an 11-year-old-girl who responded well to sub-total adrenalectomy. The significance of the Dexamethasone Suppression Test was discussed (AU)