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Case report
Cushing’s syndrome in early infancy due to isolated sporadic bilateral micronodular adrenocortical disease associated with myosin heavy chain 8 mutation: diagnostic challenges, too many!
  1. Sananda Majumder1,
  2. Partha Pratim Chakraborty2,
  3. Prakash Chandra Ghosh1 and
  4. Mitali Bera1
  1. 1Paediatrics, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
  2. 2Endocrinology and Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
  1. Correspondence to Partha Pratim Chakraborty; docparthapc{at}yahoo.co.in

Abstract

Endogenous Cushing’s syndrome (CS) is rare in infancy. Bilateral micronodular adrenocortical disease (BMAD), either primary pigmented nodular adrenocortical disease or the non-pigmented isolated micronodular adrenocortical disease is an important aetiology of CS in this age group, which requires bilateral adrenalectomy for cure. BMAD may be isolated, or a component of Carney complex. Isolated sporadic BMAD without other systemic manifestations poses a diagnostic challenge. Paradoxical cortisol response to dexamethasone suggests, while adrenal histopathology and mutational analysis of the culprit genes confirm BMAD. BMAD was suspected in 6-year-old infant with midnormal adrenocorticotrophic hormone, inconclusive adrenal and pituitary imaging and paradoxical increase in cortisol following high dose of dexamethasone. Exome sequencing revealed heterozygous c.354+1G>C (5′ splice site) variant in the myosin heavy chain gene (MYH8), located in chromosome 17. This particular variant has not been reported in the literature. In view of suspected phenotype and its absence in the population databases, the variant was classified as pathogenic.

  • adrenal disorders
  • paediatrics

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Footnotes

  • Contributors SM, PPC, PCG and MB were involved in diagnosis. SM,PCG and MB managed the patient. SM and PPC did the literature search and wrote the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parents/Guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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