warfarin and Cushing-Syndrome

Involutional osteoporosis is one of common diseases related to ageing. However, it is essential for physicians to exclude possibilities that it is caused by certain background diseases or disorders, such as hypercortisolism, hyperthyroidism and type 1 diabetes mellitus. In addition, there are several diseases other than osteoporosis, that are known to be associated with low bone mineral density, although osteoporosis is usually diagnosed according to bone mineral density measurements. Thus, physicians should be prepared to appropriately evaluate how bone metabolism is impaired in the face of patients with low bone mineral density.

Topics: Anticonvulsants; Antidepressive Agents; Bone and Bones; Bone Density; Cushing Syndrome; Diabetes Mellitus, Type 1; Glucocorticoids; Humans; Hyperthyroidism; Neoplasms; Osteoporosis; Warfarin

Bilateral inferior petrosal sinus sampling for ACTH with corticotrophin releasing hormone stimulation has become an established test in differentiating pituitary Cushing's disease from Cushing's syndrome due to ectopic ACTH secretion. We report two patients with Cushing's disease who developed thromboembolic complications soon after inferior petrosal sinus sampling. We discuss the possible mechanisms leading to this complication in a syndrome in which thromboembolic complications are well recognized and highlight the need for consideration of prophylactic anticoagulation.

Topics: Adenoma; Adrenocorticotropic Hormone; Adult; Anticoagulants; Cushing Syndrome; Female; Femoral Vein; Heparin; Humans; Hydrocortisone; Male; Petrosal Sinus Sampling; Pituitary Neoplasms; Pulmonary Embolism; Venous Thrombosis; Warfarin

Radiation-induced optic neuropathy is a rare complication (prevalence less than 1%) following radiotherapy of the sellar region. However, the vasculopathy in Cushing's disease predisposes to radiation-induced injury. We report the case of a 24-year-old man with Cushing's disease since he was 16. The hormonal study including bilateral inferior petrosal sinus catheterization diagnosed a pituitary right lesion, but imagiology was always negative. He underwent a transsphenoidal microadenomectomy and the pathological study showed the presence of corticotrophic hyperplasia but no adenoma. Secondary hypothyroidism and hypogonadism as well as permanent diabetes insipidus were diagnosed and because the patient was not cured he underwent a second transsphenoidal total hypophysectomy. After that and because he was still hypercortisolemic, pituitary external irradiation was given in a total dose of 6000 rad. Six months later he developed progressive bilateral visual loss. Cerebral MR revealed focal enhancement of the enlarged optic nerves and chiasm, associated with demyelination areas of the posterior visual pathways. Treatment was tried first with high doses of corticosteroids and later with anticoagulants-heparin EV. 1000 U/h during 7 days followed by warfarin, but unsuccessfully, probably because the patient was already amaurotic at the beginning of the last treatment.

Topics: Adolescent; Adult; Anticoagulants; Combined Modality Therapy; Cushing Syndrome; Glucocorticoids; Heparin; Humans; Hypogonadism; Hypophysectomy; Hypothyroidism; Male; Optic Nerve Diseases; Radiotherapy; Treatment Failure; Warfarin

Transsphenoidal surgery is the usual treatment of choice for adrenocorticotropic hormone-secreting pituitary adenomas associated with Cushing's disease. In this paper the authors investigate the complications of transsphenoidal surgery in the treatment of a contemporary series of patients with Cushing's disease.. Between January 1992 and December 1997, 105 patients with Cushing's disease underwent transsphenoidal surgery at the University of Virginia Health Sciences Center. A retrospective analysis of the complications was conducted, and the mortality rate was found to be 0.9% and permanent morbidity was 1.8%. The overall number of complications was 14 (13.3%), which included seven complications directly related to surgery; one instance of permanent diabetes insipidus; one syndrome of inappropriate secretion of antidiuretic hormone; and five medical complications (four patients developed deep vein thrombosis and one developed pneumonia).. Transsphenoidal surgery for Cushing's disease has a higher complication rate than that for pituitary adenomas in general. This is primarily related to a greater number of medical complications, most notably deep vein thrombosis, resulting from the generally debilitated state of most patients with Cushing's disease. In view of the high incidence of deep vein thrombosis in these patients, prophylaxis for thromboembolism during the perioperative period is recommended.

Topics: Adenoma; Adolescent; Adrenocorticotropic Hormone; Adult; Aged; Anticoagulants; Cause of Death; Child; Cushing Syndrome; Diabetes Insipidus; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Leg; Male; Middle Aged; Pituitary Neoplasms; Pneumonia; Postoperative Complications; Retrospective Studies; Sphenoid Bone; Survival Rate; Venous Thrombosis; Warfarin

Topics: Bilirubin; Cushing Syndrome; DDT; Enzyme Induction; Ethanol; Female; Humans; Hyperbilirubinemia; Infant, Newborn; Jaundice, Neonatal; Liver; Male; Phenobarbital; Phenytoin; Porphyrins; Pregnancy; Transferases; Warfarin