Last update:
09-Jul-2004

Clinical manifestations of the pituitary dependent endogenous hypercortisolism syndrome (Cushing’s disease) are related to both the degree and the duration of hypercortisolism. In acute onset severe hypercortisolism (characterized by high concentrations of cortisol), hypertension, edema, hypokalemia, weakness and diabetes mellitus or glucose intolerance constitute the most typical and main clinical features and chemical abnormalities. Clinical presentations arising from the liver usually occur during the disease progression and generally manifest as moderate non-alcoholic steatohepatitis (NASH). Acute hepatitis as the first manifestation of Cushing’s syndrome is very rare and, to the best of our knowledge, has not so far been reported in the literature. We report the case of a 45 year-old male with Cushing’s disease, presenting with arterial hypertension, edema of the lower extremities, hypokalemia, diabetes mellitus and a marked elevation of hepatic enzyme levels, due to NASH, which created difficulties in differential diagnosis. In conclusion, acute hepatitis can be a manifestation of Cushing’s disease and Cushing’s disease shoud be included in the differential diagnosis of acute hepatitis when other clinical manifestations suggest the diagnosis and commoner causes (i.e. viruses) have been excluded.

Key words: Acute hepatitis, Cushing’s disease, Non-alcoholic steatohepatitis.