Louard R J, Gelfand R A
Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
J Endocrinol Invest. 1991 Dec;14(11):965-9. doi: 10.1007/BF03347123.
A 33 year old woman presented with recurrent Cushing's disease 4 years after complete remission induced by pituitary surgery. On relapse she exhibited the unusual pattern of elevated indices of cortisol secretion with markedly suppressed serum DHEA-S; urinary 17-ketosteroid excretion was also below the normal range. Biochemical testing was otherwise consistent with ACTH-mediated hypercortisolism, and adrenal histopathology showed bilateral hyperplasia with no evidence of tumor. This case illustrates that serum DHEA-S is not an infallible guide to the differential diagnosis of Cushing's syndrome, and it supports the existence of a pituitary-secreted adrenal androgen stimulating factor that is distinct from ACTH.
一名33岁女性在垂体手术诱导完全缓解4年后出现复发性库欣病。复发时，她表现出皮质醇分泌指标升高但血清脱氢表雄酮硫酸盐（DHEA-S）明显受抑制的异常模式；尿17-酮类固醇排泄也低于正常范围。其他生化检测结果与促肾上腺皮质激素（ACTH）介导的皮质醇增多症一致，肾上腺组织病理学显示双侧增生，无肿瘤证据。该病例表明，血清DHEA-S并非库欣综合征鉴别诊断的可靠指标，且支持存在一种不同于ACTH的垂体分泌的肾上腺雄激素刺激因子。
