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Cushing syndrome related to leukemic infiltration of the central nervous system

  • Jaivinder Yadav and Vandana Jain EMAIL logo
Published/Copyright: January 10, 2015
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 28 Issue 5-6

Abstract

Background: Cushing syndrome (CS) due to central nervous system (CNS) infiltration of hematological malignancy is a rare finding.

Case: A 6.5-year-old boy with B cell acute lymphoblastic leukemia (ALL) came with excessive weight gain, headache, and irritability over last 2 months. CNS was not involved at diagnosis of ALL. On examination, the child had central obesity, moon facies, and buffalo hump. His height was at 3rd–25th percentile, weight was at >97th percentile, and blood pressure was >99th percentile. Serum cortisol was high in morning (25 μg/dL), at 12 a.m. (19.3 μg/dL) and remained elevated (7.5 μg/dL) after overnight dexamethasone test. Examination of cerebrospinal fluid (CSF) revealed blast cells suggestive of CNS relapse. Our second case was a 2.5-year-old girl with precursor B cell ALL, came with complaints of excessive weight gain, and increased appetite over last 3 months. On examination, the child had Cushingoid facies with trunkal obesity. Blood pressure was normal. Serum cortisol at 8 a.m. (40.4 μg/dL), midnight (13.8 μg/dL), and after dexamethasone suppression test (22 μg/dL) was high. CSF examination showed blast cells. We diagnosed both cases with adrenocorticotropic hormone-dependent CS due to CNS relapse based on the above findings.

Conclusion: We have reported two cases of CS due to CNS relapse of ALL. CS is a very rare manifestation of CNS relapse in patients with leukemia, and the exact pathogenesis is not clear.

Keywords: acute lymphoblastic leukemia; central nervous system infiltration; Cushing syndrome
Corresponding author: Vandana Jain, MD, Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India, E-mail:

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Received: 2014-10-26
Accepted: 2014-11-24
Published Online: 2015-1-10
Published in Print: 2015-5-1

©2015 by De Gruyter

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https://doi.org/10.1515/jpem-2014-0434
Keywords for this article
acute lymphoblastic leukemia; central nervous system infiltration; Cushing syndrome

Articles in the same Issue

  1. Frontmatter
  2. Highlight: Obesity
  3. Childhood obesity at the crossroads
  4. Obesogenic environments: environmental approaches to obesity prevention
  5. Childhood obesity and eating behaviour
  6. Hypothalamic obesity in children: pathophysiology to clinical management
  7. The reliability of body mass index in the diagnosis of obesity and metabolic risk in children
  8. Determining abdominal obesity cut-offs and relevant risk factors for anthropometric indices in Turkish children and adolescents
  9. The effect of body mass index on blood pressure varies by race among obese children
  10. Insulin secretion response during oral glucose tolerance test is related to low cardiorespiratory fitness in obese adolescents
  11. Is there a relationship between cardiovascular risk factors and dehydroepiandrosterone sulfate levels in childhood obesity?
  12. The effect of lifestyle change and metformin therapy on serum arylesterase and paraoxonase activity in obese children
  13. Childhood obesity, thyroid function, and insulin resistance – is there a link? A longitudinal study
  14. Associations between IGF-I, IGF-binding proteins and bone turnover markers in prepubertal obese children
  15. Osteocalcin is inversely associated with adiposity and leptin in adolescent boys
  16. Association between cardiovascular risk factors and carotid intima-media thickness in prepubertal Brazilian children
  17. Insulin resistance and cardiometabolic risk factors in obese children and adolescents: a hierarchical approach
  18. The role of apolipoprotein E polymorphism in improving dyslipidemia in obese adolescents following physical exercise and National Cholesterol Education Program Step II intervention
  19. Review article
  20. Is ultrasound useful in the diagnosis of adolescents with polycystic ovary syndrome?
  21. Original articles
  22. IGF-II expression and methylation in small for gestational age infants
  23. Early screening of FTO and MC4R variants in newborns of Greek origin
  24. Pitfalls in hormonal diagnosis of 17-beta hydroxysteroid dehydrogenase III deficiency
  25. The prevalence of vitamin D deficiency among schoolchildren: a cohort study from Xinxiang, China
  26. Management of testosterone therapy in adolescents and young men with hypogonadism: are we following adult clinical practice guidelines?
  27. Vitamin D status and its associations with components of metabolic syndrome in healthy children
  28. Metformin treatment improves weight and dyslipidemia in children with metabolic syndrome
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  31. Ovarian carcinoma in a 14-year-old with classical salt-wasting congenital adrenal hyperplasia and bilateral adrenalectomy
  32. An asymptomatic mother diagnosed with 3-methylcrotonyl-CoA carboxylase deficiency after newborn screening
  33. A new missense mutation in the BCKDHB gene causes the classic form of maple syrup urine disease (MSUD)
  34. Ovotesticular disorder of sex development with unusual karyotype: patient report
  35. First case report of medium-chain acyl-coenzyme A dehydrogenase deficiency in China
  36. Virilizing adrenal oncocytoma in a 9-year-old girl: rare neoplasm with an intriguing postoperative course
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  43. Cushing syndrome related to leukemic infiltration of the central nervous system
  44. Hashimoto’s encephalopathy: a rare pediatric brain disease
  45. Short communication
  46. A novel ABCD1 gene mutation in a Chinese patient with X-linked adrenoleukodystrophy
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