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Cushing syndrome related to leukemic infiltration of the central nervous system: a case report and a possible role of LIF

  • Nursel Muratoglu Sahin EMAIL logo , Zekai Avci , Baris Malbora , Ayhan Abaci , Sibel Tulgar Kinik and Namik Yasar Ozbek
Published/Copyright: May 17, 2013
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 26 Issue 9-10

Abstract

Background: Adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome (CS) in the presence of leukemic central nervous system infiltration is very rare.

Case: A 3.8-year-old girl who had been treated for B-cell acute lymphoblastic leukemia (ALL) for 1.5 years was admitted to our hospital with excessive weight gain and depression for the last 2 months. Prior to her admission, she was on maintenance with the ALL-BFM95 study protocol for 10 months that does not contain corticosteroids. On physical examination, central obesity and moon face appearance were determined. Laboratory tests revealed high morning ACTH, cortisol level, and 24-h urinary free cortisol level. Morning cortisol level was 33.94 nmol/L after a 2-day (4×0.5 mg) dexamethasone suppression test. A lumbar puncture revealed leukemic cells in the cerebrospinal fluid. No pituitary adenoma was detected on magnetic resonance imaging. We diagnosed the patient with ACTH-dependent CS related to leukemic infiltration of the central nervous system.

Conclusion: Central nervous system infiltration should be considered in leukemic patients who have developed CS. We believe increased leukemia inhibitory factor levels may be a factor for CS in our patient with ALL.

Keywords: acute lymphoblastic leukemia (ALL); Cushing syndrome; leukemic central nervous system infiltration; leukemia inhibitory factor (LIF)
Corresponding author: Nursel Muratoglu Sahin, Department of Pediatric Endocrinology, School of Medicine, Baskent University, Fevzi Cakmak Cad. 10. Sokak No: 45, 06490 Bahcelievler, Ankara, Turkey, Phone: +90-312-215-21-14, Fax: +90-312-215-75-97, E-mail:

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Received: 2012-12-14
Accepted: 2013-4-1
Published Online: 2013-05-17
Published in Print: 2013-10-01

©2013 by Walter de Gruyter Berlin Boston

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https://doi.org/10.1515/jpem-2012-0401
Keywords for this article
acute lymphoblastic leukemia (ALL); Cushing syndrome; leukemic central nervous system infiltration; leukemia inhibitory factor (LIF)

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  1. Masthead
  2. Masthead
  3. Review article
  4. Tamoxifen therapy for the management of pubertal gynecomastia: a systematic review
  5. Images in pediatric endocrinology
  6. Solitary median maxillary central incisor, a clinical predictor of hypoplastic anterior pituitary, ectopic neurohypophysis and growth hormone deficiency
  7. A rare case of granuloma annulare in a 6-year-old child with type 1 diabetes
  8. Original articles
  9. The arginine stimulation test: timing of peak is not a helpful parameter in the diagnosis of growth hormone deficiency
  10. The relationship between adiposity and stature in prepubertal children with celiac disease
  11. Influence of micronutrient status and socioeconomic gradient on growth indices of 2–18-year-old Indian girls
  12. Phosphotyrosine phosphatases in GH-stimulated skin fibroblasts from children with idiopathic short stature
  13. The relation between salivary cortisol and the metabolic syndrome score in girls
  14. Association of vitamin D concentrations with adiposity indices among preadolescent children in Korea
  15. Association of serum resistin levels with metabolic syndrome and early atherosclerosis in obese Chinese children
  16. Characteristics of infants at risk of hypoglycaemia secondary to being ‘infant of a diabetic mother’
  17. Parental dyadic coping in families of children and adolescents with type 1 diabetes
  18. Pigmentary hypertrichosis and non-autoimmune insulin-dependent diabetes mellitus (PHID) syndrome is associated with severe chronic inflammation and cardiomyopathy, and represents a new monogenic autoinflammatory syndrome
  19. Effect of insulin therapy on IGF-1 level in children with new-onset type 1 diabetes mellitus: a comparison between DKA and non-DKA
  20. Mutation analysis of the SRD5A2, AR and SF-1 genes in 52 Chinese boys with hypospadias
  21. Sexual development in prepubertal obese boys: a 4-year longitudinal study
  22. Genetic diagnosis of one family with incomplete clinical data
  23. Patient reports
  24. Complete androgen insensitivity syndrome and discordant Müllerian remnants: two cases with novel mutation in the androgen receptor
  25. Psychosexual outcomes in three siblings with partial androgen insensitivity syndrome: impact of nature versus nurture
  26. Ambiguous genitalia in a 48, XXYY newborn: a casual relationship or a coincidence?
  27. Gonadal function of beta-thalassemics following stem cell transplantation conditioned with myeloablative and reduced intensity regimens
  28. Significant testicular enlargement in a 6.5-year-old boy with monorchism and testicular microlithiasis
  29. Report of the first case of precocious puberty in Rett syndrome
  30. Type II vitamin D-dependent rickets with diabetic ketoacidosis
  31. Pituitary gigantism presenting with depressive mood disorder and diabetic ketoacidosis in an Asian adolescent
  32. A rare association between Rathke’s cyst and hypophysitis in a patient with delayed sex development and growth failure
  33. Diabetes mellitus with Laron syndrome: case report
  34. Wegener granulomatosis as an uncommon cause of panhypopituitarism in childhood
  35. Rare cases of autoimmune hypothyroidism in young children
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  37. Early presentation of bilateral gonadoblastomas in a Denys-Drash syndrome patient: a cautionary tale for prophylactic gonadectomy
  38. Identification of a novel homozygous mutation (S144I) in a Malay patient with maple syrup urine disease
  39. Virilization in two pre-pubertal children exposed to topical androgen
  40. A family with Camurati-Engelman disease. The role of the missense p.R218C mutation in TGFB1 in bones and endocrine glands
  41. Short communications
  42. Plasma ceramides are elevated in female children and adolescents with type 2 diabetes
  43. Assessment of contractility and myocardial function in small and appropriate for gestational age premature neonates using the stress-velocity relationship and tissue Doppler imaging immediately after birth
  44. Letter to the Editors
  45. Homeostasis model assessment of insulin resistance may not be reliable to evaluate insulin sensitivity in young obese children
  46. Type 1 diabetes in women with endometriosis: what is the risk of occurrence?
  47. How should we manage vitamin D-deficient adolescents?
  48. Should neonatal hyperparathyroidism associated with mucolipidosis II/III be treated pharmacologically?a
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