J Korean Soc Endocrinol.  2006 Feb;21(1):58-62. 10.3803/jkes.2006.21.1.58.

A Case of Adrenocortical Adenoma Causing Subclinical Cushing's Syndrome Mistaken for Liddle's Syndrome

• Kim KH
• Kim KH
• Ryu HY
• Nam SM
• Lee MY
• Koh JH
• Shin JY
• Jung SH
• Chung CH

• KMID: 2200664
• DOI: http://doi.org/10.3803/jkes.2006.21.1.58

Abstract

Subclinical Cushing's syndrome is defined as an autonomous cortisol hyperproduction without specific clinical signs of cortisol excess, but detectable biochemically as derangements of the hypothalamic-pituitary-adrenal axis function. We report a case of a 33-year-old woman with subclinical Cushing's syndrome caused by left adrenocortical adenoma, mistaken for Liddle's syndrome. The patient complained of fatigue. Laboratory findings showed metabolic alkalosis, hypokalemia, high TTKG (transtubular K concentration gradient), low plasma renin activity, and low serum aldosterone level, that findings implied as Liddle's syndrome. So we performed further study. Hormonal and radiologic studies revealed subclinical Cushing's syndrome with a left adrenal mass. The adrenal mass was resected and pathologically diagnosed as adrenocortical adenoma. After the resection of the left adrenal mass, patient's hormonal levels showed normal range.

MeSH Terms

Adrenocortical Adenoma*
Adult
Aldosterone
Alkalosis
Axis, Cervical Vertebra
Cushing Syndrome*
Fatigue
Female
Humans
Hydrocortisone
Hypokalemia
Plasma
Reference Values
Renin
Aldosterone
Hydrocortisone
Renin

Figure

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  Fig. 1 Computed tomography of the abdomen showing 3 × 2 cm sized, oval shaped left adrenal mass.

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  Fig. 2 Whole body scans were obtained 3 days (A), 5 days (B), 7 days (C) after injection of I-131 NP59 1 mCi. Adrenal scan [59-[131I]iodocholesterol scanning (NP59 scan)] showed nodular activity in the region of left adrenal gland.

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  Fig. 3 The tumor (3.2 × 3 × 2 cm sized) is well-circumscribed and bright yellow in color.

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  Fig.4 Microscopic finding of the tumor. (A) The tumor is well defined and composed of clear cells and eosinophilic cells (H & E stain, × 20). (B) The tumor cells have abundant clear cytoplasm and a small round nucleus (H & E stain, × 200).

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