Abstract
We report 2 patients with hypercortisolism, 1 induced by Cushing's syndrome and the other by preclinical Cushing's syndrome.
Case 1: A 65-year-old woman admitted for evaluation of a left adrenal tumor discovered by computed tomography (CT) for the further study of hypertension showed no clinical evidence of Cushing's syndrome.
Case 2: A 66-year-old woman admitted for leg fatigue and edematous face had moon face, central obesity, and ecchymosis.
In both patients, the diurnal rhythm of plasma cortisol was absent, an overnight 8 mg dexamethasone test showed no suppression of the plasma cortisol level, and plasma ACTH was supressed. From these findings and imaging examinations, we diagnosed the patients as preclinical Cushing's syndrome (Case 1) and Cushing's syndrome (Case 2) due to left adrenal adenoma. In both patients, 75g OGIT administered before and after surgical treatment showed improved glucose tolerance from DM to IGT. In the insulin resistance evaluation with euglycemic hyperinsulinemic glucose clamping, the metabolic clearance rate (MCR) for glucose improved from 4.2 to 10.1ml/kg/min (Case 1) and from 3.8 to 5.4ml/kg/min (Case2).
