Turner syndrome and Cushing disease - the coexistence with overlapping complications: case report and literature review

Gynecol Endocrinol. 2019 Dec;35(12):1015-1020. doi: 10.1080/09513590.2019.1631281. Epub 2019 Jun 27.

Abstract

We present an unusual case of Turner syndrome (TS) and Cushing disease (CD) in a young woman, admitted to our department seven years after a successful surgical removal of ACTH-secreting pituitary tumor. To our knowledge, this is the first ever report of these two disorders coexisting. Our patient was diagnosed with TS at the age of 16 due to primary amenorrhea and short stature. Hormone replacement therapy with estrogen was initiated, but she did not receive growth hormone therapy. At the age of 28, she developed clinical and biochemical abnormalities consistent with hypercortisolism, but the definitive diagnosis of CD was established nine years later when she was admitted to our department. Appropriate treatment was applied, however, the patient developed serious complications: a myocardial infarction, diabetes and osteoporosis. Surgical treatment appeared to improve some, but not all of the symptoms, indicating a significant contribution of concomitant TS to the severity of adverse cardiovascular and bone turnover outcomes in a subject with a genetic susceptibility to these complications. Thus, multidisciplinary evaluation in such patients is strongly indicated, particularly if more predisposing conditions are present.

Keywords: Cushing disease; Turner syndrome; body composition; cardiovascular complications; trabecular bone score.

Publication types

  • Case Reports
  • Review

MeSH terms

  • ACTH-Secreting Pituitary Adenoma / complications
  • ACTH-Secreting Pituitary Adenoma / physiopathology
  • ACTH-Secreting Pituitary Adenoma / surgery*
  • Adenoma / complications
  • Adenoma / metabolism
  • Adenoma / physiopathology
  • Adenoma / surgery*
  • Adult
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / etiology
  • Diabetes Mellitus, Type 2 / metabolism
  • Estrogen Replacement Therapy
  • Female
  • Humans
  • Myocardial Infarction / etiology
  • Osteoporosis / diagnostic imaging
  • Osteoporosis / drug therapy
  • Osteoporosis / etiology
  • Osteoporotic Fractures / etiology
  • Pituitary ACTH Hypersecretion / complications
  • Pituitary ACTH Hypersecretion / metabolism
  • Pituitary ACTH Hypersecretion / physiopathology
  • Pituitary ACTH Hypersecretion / surgery*
  • Turner Syndrome / complications
  • Turner Syndrome / drug therapy*