Cushing's Syndrome after Hemodialysis for 21 Years

Koki Mise, Yoshifumi Ubara, Keiichi Sumida, Rikako Hiramatsu, Eiko Hasegawa, Masayuki Yamanouchi, Noriko Hayami, Tatsuya Suwabe, Junichi Hoshino, Naoki Sawa, Masaji Hashimoto, Takeshi Fujii, Hironobu Sasano and Kenmei Takaichi

- Author Affiliations

Nephrology Center (K.M., Y.U., K.S., R.H., E.H., M.Y., N.H., T.S., J.H., N.S., K.T.), Surgical Gastroenterology (M.H.), Pathology (T.F.), and Okinaka Memorial Institute for Medical Research (Y.U., K.T.), Toranomon Hospital, 1058470 Tokyo, Japan; and Department of Pathology (H.S.), Tohoku University Graduate School of Medicine, 9800872 Sendai, Japan

Address all correspondence and requests for reprints to: Koki Mise, M.D., Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatu-ku, Kawasaki-shi, Kanagawa-ken, 213-0015, Japan. E-mail: kokimise@yahoo.co.jp.

Abstract

Context: Hyperkalemia and weight loss are critical clinical problems for hemodialysis patients. There have been no documented reports of adrenal Cushing's syndrome with central obesity and hypokalemia in a hemodialysis patient.

Objective: The aim of the study was to report a patient with Cushing's syndrome after chronic hemodialysis, review the published literature, and discuss the significance of hypokalemia and obesity in anuric hemodialysis patients from the perspective of cortisol metabolism.

Patient: A 61-yr-old woman who had been on hemodialysis for 21 yr presented with persistent hypokalemia and central obesity. In 2002, her dry weight was 48.1 kg, but thereafter she gained weight to 60 kg.

Results: Adrenal Cushing's syndrome was diagnosed from endocrinological findings such as increased cortisol secretion without a circadian rhythm and suppression of plasma ACTH. Spironolactone was administered (25 to 50 mg/d), and her serum potassium became normal. Then, left adrenalectomy was performed by laparoscopic surgery. The resected specimen contained a well-circumscribed adrenal adenoma expressing P450c17. After surgery, hypokalemia improved gradually without medication, and her weight gain stopped.

Conclusions: This is the first documented case of adrenal Cushing's syndrome in a patient on long-term hemodialysis, although several authors have reported a relation between hypokalemia and primary hyperaldosteronism in hemodialysis patients.

From The Journal of Clinical Endocrinology and Metabolism

Body composition and cardiovascular risk markers after remission of Cushing's disease: a prospective study using whole-body MRII

Geer EB, Shen W, Strohmayer E, Post KD, Freda PU.

J Clin Endocrinol Metab. 2012 May; 97(5):1702-11

John Newell-Price and Miguel Debono, University of Sheffield, UK. F1000 Diabetes & Endocrinology

26 Jun 2012 | Confirmation, Good for Teaching

Excess endogenous glucocorticoids cause central obesity with an increased visceral to total fat ratio and this is associated with the metabolic syndrome and insulin resistance, increasing the cardiovascular risk. This is a prospective study in 14 subjects where whole-body magnetic resonance imaging (MRI) has been used for the first...

Read this article at http://f1000.com/717297977

Cushing's Syndrome and Disease: A Disorder That Often Goes Undiagnosed

Obesity, excess neck fat and the ability to easily bruise are just a few signs of this commonly overlooked condition. Often it is caused by a tumor in the adrenal gland, which may be cancerous. Nancy D. Perrier, M.D., F.A.C.S., chief of the Section of Surgical Endocrinology at MD Anderson Cancer Center, discusses this disorder and the difference between the syndrome and disease.

Guest(s): Nancy D. Perrier, M.D., F.A.C.S.

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From http://www.mdanderson.org/newsroom/cancer-newsline/cancer-newsline-topics/2011/cancer-newsline-cushing-s-syndrome-and-disease-a-disorder-that-often-goes-undiagnosed.html