To present a case of cyclic Cushing's syndrome (cCS) and the implementation of a continuous block-and-replace therapy using osilodrostat, highlighting the rarity and diagnostic challenges associated with cCS.
Approach:
Case Presentation: A 68-year-old male with a 5-year history of recurrent hospitalizations due to infections, sepsis, and severe fluctuations in blood pressure and glycemic control was evaluated for bilateral adrenal incidentalomas. His medical history included significant cardiovascular comorbidities and osteoporosis.
Key Findings:
The patient experienced severe clinical episodes of hypercortisolemia separated by spontaneous remissions, with cortisol peaks correlating with severe hypertension, hyperglycemia, and infectious complications.
Osilodrostat was implemented as a continuous block-and-replace therapy after challenges with metyrapone, emphasizing the need for individualized treatment strategies.
Interpretation:
This case illustrates the unpredictable nature of cCS and the challenges in diagnosis and management.
Limitations:
The rarity of cCS limits generalizability of findings.
Imaging failed to identify the ACTH source, necessitating further invasive testing, including planned inferior petrosal sinus sampling.
Conclusion:
The case demonstrates the use of osilodrostat in managing cCS, emphasizing the need for tailored treatment approaches.
A large BRFSS analysis points to persistent screening disparities among sexual orientation and gender identity minority respondents, with particularly large gaps in some gender identity minority groups.
