Diagnosis of cyclic Cushing’s disease manifests as early morning hyperglycemia in a patient with previously well-controlled type 1 diabetes
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Carol Singer-Granick
und
Lissette Cespedes
Abstract
Background
Cyclic Cushing’s disease (CCD) is reported to occur in approximately 15% of patients with Cushing’s disease (CD). CCD is a rare phenomenon in children.
Case presentation
A Portuguese female with well-controlled type 1 diabetes (T1DM) on an insulin pump developed transient uncontrolled blood sugar every morning. Increased basal and bolus insulin dosing was ineffective in lowering blood sugar and she began to miss school because of nausea, vomiting, fatigue, but no ketoacidosis. Therefore, other causes of sporadic hyperglycemia were explored. Multiple 6-h urinary free cortisol (UFC) samples revealed a spike in cortisol coincident with severe hyperglycemia. Pituitary magnetic resonance imaging (MRI) revealed a 3.5 mm microadenoma and inferior petrosal sinus sampling of adrenocorticotropic hormone (ACTH) after corticotropin releasing hormone (CRH) stimulation confirmed ACTH-dependent CD. Endoscopic endonasal tumor resection led to resolution of early morning hyperglycemia and symptoms.
Discussion
Our case illustrates an atypical presentation of CCD. There are no previous case reports of a pediatric patient with T1DM and CCD. Unexplained hyperglycemia in a patient with previous well-controlled T1DM should prompt assessment of other causes. CCD can be easily be missed if timed 6-h UFC measurements are not obtained.
Acknowledgments
The authors would like to thank University Hospital, Newark, NJ for providing access to medical records and radiography.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
Disclosures: The authors have no disclosures.
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- Frontmatter
- Review
- Effect of safflower yellow on early type II diabetic nephropathy: a systematic review and meta-analysis of randomized controlled trials
- Original Articles
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- Clinical and molecular characteristics and time of diagnosis of patients with classical galactosemia in an unscreened population in Turkey
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- Auditory event-related potentials demonstrate early cognitive impairment in children with subclinical hypothyroidism
- Cardiovascular risk factors in children with type 1 diabetes mellitus
- The relationship between serum FGF-23 concentration and insulin resistance, prediabetes and dyslipidemia in obese children and adolescents
- The metabolic consequences of overweight in a cohort of children with type 1 diabetes
- The spectrum of pediatric adrenal insufficiency: insights from 34 years of experience
- Growth screening in children aged 3–5 years: a useful tool for public health programs in community pediatrics
- Selective receptor-mediated impairment of growth factor activity in neonatal- and X-linked adrenoleukodystrophy patients
- Determinants for low bone mineral density in pre-school children: a matched case-control study in Wuhan, China
- Genetic polymorphisms associated with obesity and non-alcoholic fatty liver disease in Asian Indian adolescents
- Maturity onset diabetes of the young (MODY) in Chinese children: genes and clinical phenotypes
- Severe, persistent neonatal hypoglycemia as a presenting feature in patients with congenital hypopituitarism: a review of our case series
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- Diagnosis of cyclic Cushing’s disease manifests as early morning hyperglycemia in a patient with previously well-controlled type 1 diabetes
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- Replacement of breastfeeding with medical food for the treatment of galactosemia and phenylketonuria: maternal stress
