Akinetic mutismを主症状としたCushing症候群の1症例

Abstract

A 21-year-old woman was admitted because of akinetic mutism. She exhibited hypertension (150/110 mmHg) and amenorrhea. Central obesity was not observed. ACTH levels were below the normal range (<4.0 pg/ml), and plasma cortisol level was 22.8 μg/dl. Dexamethasone suppression test was negative. CT scan, MRI and adrenal venography detected a right adrenal tumor (φ3 cm). From these findings, the patient was diagnosed as having Cushing's syndrome. After the removal of the right adrenal tumor, the patient became able to speak spontaneously and to move actively. The removed specimen showed adrenocortical adenoma pathologically. It was difficult for us to diagnose this case as Cushing's syndrome on admission, because central obesity, which is the most characteristic clinical feature of Cushing's syndrome, was not observed. Thus, in a case where patients cannot eat anything because of akinetic mutism, central obesity, reliable characteristics for diagnosis of Cushing's syndrome, may be concealed. To our best knowledge, this is the first report about akinetic mutism as a complication of Cushing's syndrome.