Endocrinol Metab.  2013 Jun;28(2):133-137. 10.3803/EnM.2013.28.2.133.

Adrenocorticotropic Hormone-Independent Cushing Syndrome with Bilateral Cortisol-Secreting Adenomas

• Ku EJ
• Hong AR
• Kim YA
• Bae JH
• Chang MS
• Kim SW

• KMID: 1973812
• DOI: http://doi.org/10.3803/EnM.2013.28.2.133

Abstract

A 48-year-old woman was incidentally found to have bilateral adrenal masses, 2.8 cm in diameter on the right, and 2.3 cm and 1.7 cm in diameter on the left, by abdominal computed tomography. The patient had a medical history of hypertension, which was not being controlled by carvedilol, at a dose of 25 mg daily. She presented with signs and symptoms that suggested Cushing Syndrome. We diagnosed adrenocorticotropic hormone (ACTH)-independent Cushing Syndrome based on the results of basal and dynamic hormone tests. Adrenal vein sampling (AVS) was performed to localize a functioning adrenal cortical mass. AVS results were consistent with hypersecretion of cortisol from both adrenal glands, with a cortisol lateralization ratio of 1.1. Upon bilateral laparoscopic adrenalectomy, bilateral ACTH-independent adrenal adenomas were found. The patient's signs and symptoms of Cushing Syndrome improved after surgery just as the blood pressure was normalized. After surgery, the patient was started on glucocorticoid and mineralocorticoid replacement therapy.

Keyword

Adrenal vein sampling; Bilateral cortisol-secreting adenomas; Cushing Syndrome

MeSH Terms

Adenoma
Adrenal Glands
Adrenalectomy
Adrenocorticotropic Hormone
Blood Pressure
Carbazoles
Cushing Syndrome
Female
Humans
Hydrocortisone
Hypertension
Propanolamines
Veins
Adrenocorticotropic Hormone
Carbazoles
Hydrocortisone
Propanolamines

Figure

• 

  Fig. 1 Adrenal computed tomography (CT). Axial images from noncontrast-enhanced adrenal CT show a right adrenal nodule 2.8 cm in diameter, and two left adrenal nodules, 2.3 and 1.7 cm, respectively, in diameter (arrows).

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  Fig. 2 (A) Gross finding of tumors. The right adrenal mass was well-circumscribed and brownish, measuring 2.6×2.5×1.6 cm in size. A left adrenal mass was dumbbell-shaped and yellowish, measuring 2.6×2.3×1.7 cm in size. (B, C) Microscopic finding of right adrenal adenoma. Microscopically, both masses were predominantly composed of large clear cells with well-differentiated cells. Nuclear atypia, mitoses, necrosis and features of vascular invasion were not found. Double-headed arrow indicates atrophy of normal adrenal tissue due to tumor (B, H&E stain, ×40; C, H&E stain, ×200).

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