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A ‘smart’ type of Cushing's syndrome

Sint Franciscus Gasthuis Rotterdam, Department of Internal Medicine, Center for Diabetes and Vascular Medicine, PO Box 10900, 3004 BA Rotterdam, The Netherlands

(Correspondence should be addressed to M C Cabezas; Email: m.castrocabezas{at}sfg.nl)

Abstract

Cushing's syndrome results from lengthy and inappropriate exposure to excessive concentrations of either endogenous or exogenous glucocorticoids. This case report describes a patient with a novel type of Cushing's syndrome due to the use of party drugs. A 35-year-old woman had gained 8 kg body weight in 5 months and complained of anxiety. She showed a Cushing-like appearance and mild hypertension (blood pressure, BP 150/95 mmHg). She reported daily use of increasing doses of -hydroxybutyric acid (GHB), a popular party drug. ACTH plasma levels were in the upper normal range (41 ng/l), with normal plasma cortisol (0.36 µmol/l). She showed an abnormal overnight 1 mg dexamethasone suppression test (cortisol 0.38 µmol/l). The urinary excretion of free cortisol in 24 h was also increased (0.47 µmol/24 h). CT scanning of the abdomen showed normal adrenals. After stopping GHB intake she lost 7 kg body weight and her BP normalized (BP 135/80 mmHg). GHB is a popular party drug in the Netherlands, but it is also used as a narcotic and for the treatment of narcolepsy. We hypothesize that GHB may bind to the pituitary gland -aminobutyric acid-B receptors leading to ACTH overproduction.