SAT-220 Oral Contraceptives and Their Effect on the Evaluation of Cushing's Syndrome: A Case Report

• DOI: 10.1210/js.2019-sat-220
• Publication Date: 2019-05-10T07:20:06Z
• Authors: Zhi Guang Ng; Seng Kiong Tan; Timothy Peng Lim ...
• Keywords: hirsutism; Dexamethasone suppression test

Background In the evaluation of Cushing’s syndrome (CS), oral contraceptives may lead to false-positive results by raising serum levels cortisol-binding globulin (CBG). Clinical Case An 18-year old Chinese lady presented with weight gain, irregular menses and hirsutism. History was unremarkable for hypothyroidism, hyperprolactinemia, eating disorders, exogenous steroid use. On examination, she overweight (body mass index (BMI) 26.9 kg/m2) rounded facies, hirsutism dorsal cervical fat pad. Initial biochemical tests showed high cortisol ACTH levels: 66.6 pmol/L (RI 0-10.2 pmol/L) random 958 nmol/L (RI: 240-618 nmol/L). She referred our department possible syndrome. Further history revealed that patient on a combined estrogen-progestin contraceptive pill (OCP). Confirmatory after cessation OCP 6 weeks normal 24-hr urinary (231 255 nmol/day, RI: 59-413 nmol/day) 1 mg dexamethasone suppression test (44 administration overnight, RI <50nmol/L). A progesterone challenge induced withdrawal bleeding, consistent an estrogen-sufficient anovulatory state such as seen in Polycystic Ovarian Syndrome. Regular menstrual cycles returned deliberate loss BMI 26.0 kg/m2). Discussion Conclusion OCPs increase total concentrations increasing circulating CBG without affecting unbound fraction (1). Women hence display elevated increased activity. These elevations are dependent estrogen dose, usually not progestogen-only or low-dose (0.05 mestranol less) preparations (2). Other drugs interfering clearance, CYP3A4 inhibitors inducers, also influence (3). Current guidelines suggest estrogen-containing should be discontinued at least so prevent results, which can potentially unnecessary procedures surgery. thorough drug is therefore crucial CS. References (1) Qureshi AC, Bahri A, Breen LA, et al. The route oestrogen cortisol. Clin Endocrinol (Oxf). 2007; 66: 632-5 (2) C. W. Burke. effect metabolism. J Pathol Suppl (Assoc Pathol). 1969; 3: 11-18. (3) M. Vastbinder, Kuindersma overnight test. Neth Med. 2016 May;74(4): 158-61.