Spontaneous Remission in a Case of Cushings Syndrome

Abstract

Cushing’s syndrome is usually caused by hyperplasia or carcinoma of the adrenal cortex; less frequently it is associated with a basophil tumor of the pituitary, with or without adrenal hyperplasia; exceptionally it is observed in the presence of an ovarian or a thymic tumor; and in rare instances autopsy of typical cases of Cushing’s syndrome reveals no organic lesion in the endocrine glands. Irrespective of its original cause, the evolution of all known cases has followed a progressive course which could only be delayed by means of pituitary irradiation, ample adrenalectomy, or death of the patient due to some intercurrent infection. Spontaneous remission in cases of Cushing’s syndrome with well-defined somatic alterations is mentioned only exceptionally in the literature, and for this reason we consider as most interesting the description of a typical case, including adrenal hyperplasia, in which there was spontaneous evolution to complete cure.

Case Details

Personal Characteristics

Unmarried woman, 21 years old, born in the province of catamarca, argentina. History of fever resembling brucellosis at 11 years old, measles and mumps at 16, german measles at 20. Menses began at the age of 14 1/2; the interval was twenty-five days and the bleeding lasted for three days.

Clinical Characteristics

Two months of amenorrhea after two years of irregular menses with periods of oligomenorrhea associated with hypomenorrhea and hypermenorrhea; headache with elective retro-ocular localization during the preceding year; and an increase in weight from 62 to 69 kilograms during the same period. Obesity was most prominent in the face and was associated with substantial changes in features and expression. Gradual increase in facial and body hair, and marked shedding of scalp hair. Atrophic striae in different parts of the body, which increased gradually in number and size. Pain in the interior thorax, spreading forward in the form of a belt.

Remission Characteristics

In august 1953 menstruation, although scanty, reappeared and continued monthly. In december her weight was 66.4 kilograms, with a general decrease in adipose tissue and a decrease in the symptoms typical of cushings syndrome. In january 1954, all pathologic somatic characteristics had become much less pronounced, the cutaneous striae were becoming pale and the skin was more normal in appearance. In april the improvement was marked. The patients weight was 61.9 kilograms, the blood pressure was 110/75, and there was a great change in her facial expression. In july 1954 her features and somatic configuration were completely normal in spite of an increase in weight to 65.5 kilograms, the cutaneous striae were completely pale and the blood pressure was 90/60.

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

No treatment was instituted except for a restriction in caloric intake. Methyltestosterone in a dosage of 10 milligrams daily was given for a few days.

Non-Clinical Treatment

The patient retained a good appetite, having reduced voluntarily the amount of carbohydrates and sodium chloride consumed, for the purpose of losing weight.

Additional Notes

The patient had Cushings syndrome for almost a year, and then returned to her physical status prior to the disease and was completely free of symptoms. Menstruation was normal.