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    • "Glucocorticoids negatively affect this mechanism, and thus, produce an immunosuppressive condition. Several invasive fungal infections, including cryptococcosis, PJP, invasive aspergillosis, invasive candidiasis, and histoplasmosis , have been reported in endogenous Cushing syn- drome[17]. Invasive aspergillosis is the most common invasive mold infection associated with glucocorticoids[14]. Cases of invasive aspergillosis in ectopic ACTH syndrome have been reported. "
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    ABSTRACT: Adrenocorticotropic hormone (ACTH)-producing pheochromocytoma has been rarely reported, whereas only a few cases of Cushing syndrome accompanied by opportunistic infections have been reported. We experienced a patient with pheochromocytoma with ectopic Cushing syndrome complicated by invasive aspergillosis. A 35-year-old woman presented with typical Cushingoid features. Her basal plasma cortisol, ACTH, and 24-hour urine free cortisol levels were significantly high, and 24-hour urine metanephrine and catecholamine levels were slightly elevated. The endogeneous cortisol secretion was not suppressed by either low- or high-dose dexamethasone. Abdominal computed tomography (CT) revealed a heterogeneous enhancing mass measuring approximately 2.5 cm in size in the left adrenal gland. No definitive mass lesion was observed on sellar magnetic resonance imaging. On fluorine-18 fluorodeoxyglucose positron emission tomography/CT, a hypermetabolic nodule was observed in the left upper lung. Thus, we performed a percutaneous needle biopsy, which revealed inflammation, not malignancy. Thereafter, we performed a laparoscopic left adrenalectomy, and its pathologic finding was a pheochromocytoma with positive immunohistostaining for ACTH. After surgery, the biochemistry was normalized, but the clinical course was fatal despite intensive care because of the invasive aspergillosis that included the lungs, retina, and central nervous system.
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    • "Minor wounds or abrasions may heal poorly. In addition, because of the immunosuppressive effects of hypercortisolism, superficial mucocutaneous fungal infections such as tinea versicolor also may be seen [11]. Although androgen excess may be present and result in facial hirsutism, vellus hypertrichosis (lanugo hair) that is glucocorticoid-dependent is probably more common in women who have Cushing's syndrome. "
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    ABSTRACT: Screening studies in high-risk populations have suggested that Cushing's syndrome is more common than previously appreciated. Patients who have specific signs and symptoms or clinical diagnoses known to be associated with hypercortisolism should be considered for screening. The measurement of late-night salivary cortisol provides the most sensitive method for screening, and urine-free cortisol and low-dose dexamethasone suppression testing may be used for confirmation of the diagnosis of endogenous hypercortisolism
    Full-text · Article · Jul 2005 · Endocrinology & Metabolism Clinics of North America
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    ABSTRACT: Pseudallescheria boydii infection involving the left distal femur and knee joint developed in a patient with Cushing's disease, and recurred after treatment with both intravenous miconazole and intravenous amphotericin B. The patient subsequently had synovectomy and arthrodesis, and received ketoconazole, 600 mg per day orally for one year. Concurrent with the start of ketoconazole, a bilateral adrenalectomy was done to control endogenous hypercortisolism. The patient's infection then resolved, and one year afterward there is no clinical or radiologic evidence of recurrent infection.
    No preview · Article · Feb 1987 · Southern Medical Journal
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