Clinical Report: Implementation of a Continuous Block-and-Replace Approach Using Osilodrostat in a Patient with Cyclic Cushing's Syndrome
Overview
This case study presents a 68-year-old male with cyclic Cushing's syndrome (cCS) who experienced severe fluctuations in cortisol levels leading to recurrent hospitalizations.
Background
Cyclic Cushing's syndrome is characterized by intermittent phases of hypercortisolism and normo/hypocortisolism, complicating diagnosis and management. The unpredictable nature of cCS can lead to life-threatening episodes.
Data Highlights
Parameter
Value
ACTH
Not suppressed
Cortisol peak
34.43-43.5 ug/dl
Cortisol trough
8–13 ug/dl
Hypokalemia
2.47 mmol/l
Key Findings
The patient had a 5-year history of recurrent hospitalizations due to severe infections and metabolic instability.
Biochemical tests confirmed ACTH-dependent Cushing's syndrome with dynamic tests suggesting an ectopic origin.
Retrospective analysis revealed seven severe episodes of hypercortisolemia separated by spontaneous remissions.
Imaging failed to identify the ACTH source, leading to plans for inferior petrosal sinus sampling.
Clinical Implications
This case highlights the challenges in diagnosing cyclic Cushing's syndrome.
Conclusion
This case illustrates the challenges in diagnosing and managing cyclic Cushing's syndrome.
