Menstrual irregularities occur in 30–80% of women with Cushing’s syndrome, yet the diagnosis is often missed when amenorrhoea presents without classical features.

Alhajeri et al. present the case of a 33-year-old woman who presented with six months of amenorrhoea following discontinuation of oral contraceptives, which had been prescribed for presumed polycystic ovary syndrome (PCOS) two years before. She had non-specific symptoms including joint pain, mild weight gain (body mass index 21.8kg/m2), fatigue, mild facial acne and mood changes.

Initial hormonal work-up revealed central hypogonadism (luteinising hormone 0.35mIU/ml, follicle-stimulating hormone 5mIU/ml and oestradiol <5pg/ml) and secondary hypothyroidism (thyrotrophin 0.5μIU/ml, free thyroxine 11.4pmol/l). Elevated morning cortisol (753mmol/l), failure to suppress with low-dose dexamethasone (600mmol/l) and markedly raised 24-hour urinary cortisol (16,712nmol/l) confirmed hypercortisolism. Imaging confirmed a cortisol-secreting adrenal adenoma. Following laparoscopic adrenalectomy, her menstrual cycles resumed, and her pituitary function recovered.

This case reinforces a key clinical lesson: in women with amenorrhoea and central hypogonadism (particularly those lacking overt hyperandrogenism), Cushing’s syndrome must be considered. For endocrinologists evaluating reproductive dysfunction, cortisol excess should not be ruled out solely due to the absence of classic signs.

Read the full article in Endocrinology, Diabetes & Metabolism Case Reports EDM-23-0152 https://doi.org/10.1530/EDM-23-0152