Introduction
Case series
Patient 1
Patient 1 | Patient 2 | |
---|---|---|
ACTH (7–63 ng/l) | 1.91 | 1.29 |
Cortisol (133–537 nmol/l) | 371.0 | 1696.0 |
Urinary cortisol (3.0–43.0 mcg/d) | 328.3 | 2487.0 |
23 h Salivary cortisol (<4,1 ng/ml) | 18.4; 14.4 | 25.2 |
Cortisol following 1 mg dexamethasone suppression test (mcg/l) | 145.0 | >634.0 |
Cortisol following 8 mg dexamethasone suppression test (nmol/l) | 264.0 | Refused by patient |
CRH-test | Cortisol: 249.0 (0 min) -255.0 (15 min) -251.0 (30 min) -250.0 (45 min) -244.0 (60 min) -244.0 (90 min) - 242.0 (120 min) | Cortisol: 1102.0 (0 min) -1185.6 (15 min) -1145.1 (30 min) - 1108.6 (45 min) -1041.6 (60 min) -1038.2 (90 min) -1038.0 min (120 min) |
ACTH: < 1,5 (0 min) -1.62 (15 min) -1.77 (30 min) - 2.09 (45 min) -1.95 (60 min) -1.78 (90 min) -1.69 (120 min) | ACTH: 1.8 (0 min) - 2.0 (15 min) - 3.8 (30 min) - 3.0 (45 min) - 2.9 (60 min) -2.8 (90 min) -2.68 (120 min) | |
Prolactin (4.8–23.3 mcg/l) | 74.7 | 21.2, 101.5 (12 weeks later) |
GH (0–6.88 mcg/l) | 3.27 | |
IGF-1 (117–329 ng/ml) | 349.0 464.8 (4 weeks later) | 218.0, 958.2 (12 weeks later) |
GH suppression test | 2.05 (0 min) - 1.19 (30 min) - 1.49 (60 min) - 1.56 (120 min) | |
oGTT (mg/dl) | 70 (0 min) - 190 (60 min) -116 (120 min) | 103 (0 min) - 229 (60 min) - 256 (120 min) |
TSH (0.27–4.2 mIU/ml) | 1.66 | 1.14 |
fT3 (2.0–4.4 pg/ml) | 3.27 | 1.3 |
fT4 (9.3–17.0 ng/l) | 10.48 | 8.1 |
FSH (mIE/ml) | 7.4 | <0.1 |
LH (mIE/ml) | 18.6 | <0.1 |
Estradiol (pg/ml) | 36.2 | <5.0 |
Patient 2
Patient 3
Genetics
Follow-up
Carney complex
Epidemiology
Clinical features and diagnostic criteria
Manifestations | Frequency | Symptoms | Age at manifestation | Complications | CAVEAT: |
---|---|---|---|---|---|
Skin lesions | more than 80%, most common [34] | lentigines (70–80%), blue nevus (40%), cutaenous myxomas (30–50%) [34] | adolescence | among the earliest and most easy to detect [34] | |
Cardiac tumors | 20–40% [8] | cardiac myxomas | mean age: females 28.7 years, males 25.0 years [35] | ||
Pituitary tumors | rarely signs of acromegaly | 20–30 years | complications of untreated acromegaly | histological work-up of the tumor resections: frequently immunostaining not only for GH but also for prolactin and TSH alpha subunit [7] | |
Adrenocortical tumors | hypercortisolism due to PPNAD, subclinical or overt (1/4) [42] | second and third decades [1] | very few cases of adrenocortical carcinomas [43] | most common endocrine manifestation | |
Ophthalmologic manifestations | up to 70% [44] | whole lifespan | usually precede more serious manifestations, e.g., cardiac myxoma [44] | ||
Psammomatous melanotic schwannomas | up to 10% | 30–40 years [47] | |||
Thyroid neoplasms | |||||
Breast tumors | typically, multiple | ||||
Ovarian lesions | ovarian cysts, serous cystadenomas and cystic teratomas | after puberty | |||
Testicular tumors | up to 75% | childhood | |||
Bone lesions | osteochondromyxomas have the potential to be locally invasive and to recur [65] | typically associated with CNC [66] | |||
Other tumors |
Genetics
Treatment
Prognosis
Surveillance
Annually | Echocardiogram (biannually if a cardiac myxoma has already been excised); testicular ultrasound for boys; monitoring of growth rate and pubertal stage | Echocardiogram (biannually if a cardiac myxoma has already been excised); testicular ultrasound; skin evaluations; endocrine tests: serum: GH, IGF-I, prolactin, urine: free cortisol and other testing for Cushing´s syndrome if appropriate |
Baseline and/or if required | Thyroid ultrasound; transabdominal ultrasound of the ovaries; imaging as required (e.g., CT of the adrenals, MRI spine/chest/abdomen/retroperitoneum/pelvis); oGTT if needed |