Cushing's syndrome and acute lymphoblastic leukemia
M. Danon, E. N. Beckman, J. C. Kase, R. Toch and J. D. Crawford
Cushing's disease developed in a 5-year-old girl with acute lymphoblastic
leukemia 18 months after her last therapeutic exposure to adrenal
glucocorticosteroids. Obesity, hyperpigmentation, striae, osteoporosis, and
hirsutism were accompanied by elevated levels of plasma cortisol. These
showed no diurnal fluctuation and they were not suppressed by
dexamethasone. At autopsy, the adrenal glands were enlarged and the
pituitary gland showed increased numbers of basophils of the
adrenocorticotropic hormone (ACTH)/melanocyte-stimulating hormone secreting
type. Leukemic infiltrates in brain tissue were prominent in the
hypothalamus and in the limbic system. It is postulated that the
destructive leukemic infiltrate of the limbic system removed a restraining
influence on pituitary function, with basophilic hyperplasia, ACTH
hypersecretion, adrenocortical hypertrophy, and clinical Cushing's disease
the consequences.