Macronodular Adrenal Hyperplasia with Hypothalamic‐Pituitary-Adrenal Suppression by Ultra‐High-Dose DexamethasoneRegression Following Hypophysectomy
作者:
Hamilton Fish,
Douglas Sobel,
Carol Miegel,
期刊:
Clinical Neuropharmacology
(OVID Available online 1986)
卷期:
Volume 9,
issue 3
页码: 303-308
ISSN:0362-5664
年代: 1986
出版商: OVID
关键词: Macronodular adrenal hyperplasia;Cushing's syndrome;Dexamethasone.
数据来源: OVID
摘要:
Summary:Cushing's syndrome associated with macronodular adrenal hyperplasia (MAH) may present with high-dose dexamethasone (dex) nonsuppressible hypercortisolemia. This has been interpreted as suggesting a primary adrenal disorder, leading to recommendations for curative adrenalectomy in these cases. The present case of MAH demonstrates high urinary and serum cortisol levels, sufficiently suppressed only by ultra-high-dose (32 mg/day × 2 day) dex, with parallel reduction of plasma adrenocorticotrophin noted as well. Subsequent clinical cure by transsphenoidal hypophysectomy and identification of a pituitary adenoma confirmed the secondary nature of adrenal cortical hypersecretion. The conceptual evolution of macronodules and altered feedback dynamics of the hypothalamo-pituitary-adrenal axis in MAH are briefly discussed.
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