P-50 We Know You Are There: Missing Mass

January 2025 in “ JCEM Case Reports ”

Hazal Salva, Özlem Üstay

Cushing's Disease male-pattern hair loss elevated cortisol Desmopressin Metyrapone

TLDR Metyrapone can effectively treat Cushing's Disease even if the mass causing it is not found.

This case study discusses a 40-year-old female patient with Cushing's Disease (CD) where the causative mass could not be identified through imaging. Despite having symptoms like male-pattern hair loss, abdominal obesity, and elevated cortisol levels, pituitary MRI and abdominal CT scans showed no mass lesions. The patient had a complex medical history, including bipolar disorder, type 2 diabetes, and hypertriglyceridemia, which were managed with various medications and lifestyle changes. Intravenous Desmopressin stimulation test confirmed CD, and treatment with Metyrapone was initiated, leading to significant improvements in her condition, including weight loss and reduced triglyceride levels. This case highlights Metyrapone as a viable treatment option for CD when the mass is undetectable.

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P-50 We Know You Are There: Missing Mass

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