A case of adrenal Cushing's syndrome with bilateral adrenal masses. (1st May 2016)

• Record Type: Journal Article
• Authors: Guo, Ya-Wun; Hwu, Chii-Min; Won, Justin Ging-Shing; Chu, Chia-Huei; Lin, Liang-Yu
• Is Part Of: Endocrinology, diabetes & metabolism case reports. (2016)
• Publication Date: 2016-05-01
• Subjects: Adult -- Female -- Asian - Chinese -- Taiwan, Province of China; Adrenal -- Adrenal -- Cortisol -- ACTH -- Cushing's syndrome -- Adrenocortical adenoma; Weight gain -- Facial fullness -- Facial plethora -- Ecchymoses -- Hypercholesterolaemia -- Adrenal venous sampling -- Adrenal scintigraphy -- CT scan -- Dexamethasone suppression (low dose) -- Dexamethasone suppression (high dose) -- ACTH -- Cortisol day curve -- Cortisol, free (24-hour urine) -- Cortisol (plasma) -- Aldosterone (plasma) -- Epinephrine (plasma) -- Histopathology -- Histopathology -- Weight -- Waist circumference -- Haemoglobin -- Sodium -- LDL cholesterol -- Laparoscopic adrenalectomy -- Hydrocortisone -- Glucocorticoids; Unique/unexpected symptoms or presentations of a disease -- May -- 2016; Endocrinology -- Periodicals; Diabetes -- Periodicals; Diabetes Mellitus; Endocrinology; Diabetes; Endocrinology; Case Reports; Periodicals; Periodicals; 616.4
• DOI: 10.1530/EDM-15-0118
• Languages: English
• ISSNs: 2052-0573

Abstract

Summary: A functional lesion in corticotrophin (ACTH)-independent Cushing's syndrome is difficult to distinguish from lesions of bilateral adrenal masses. Methods for distinguishing these lesions include adrenal venous sampling and 131 I-6β-iodomethyl-19-norcholesterol ( 131 I-NP-59) scintigraphy. We present a case of a 29-year-old Han Chinese female patient with a history of hypercholesterolaemia and polycystic ovary syndrome. She presented with a 6month history of an 8kg body weight gain and gradual rounding of the face. Serial examinations revealed loss of circadian rhythm of cortisol, elevated urinary free-cortisol level and undetectable ACTH level (<5pg/mL). No suppression was observed in both the low- and high-dose dexamethasone suppression tests. Adrenal computed tomography revealed bilateral adrenal masses. Adrenal venous sampling was performed, and the right-to-left lateralisation ratio was 14.29. The finding from adrenal scintigraphy with NP-59 was consistent with right adrenal adenoma. The patient underwent laparoscopic right adrenalectomy, and the pathology report showed adrenocortical adenoma. Her postoperative cortisol level was 3.2μg/dL, and her Cushingoid appearance improved. In sum, both adrenal venous sampling and 131 I-NP-59 scintigraphy are good diagnostic methods for Cushing's syndrome presenting with bilateral adrenal masses. Learning points: The clinical presentation of Cushing' syndrome includes symptoms and signs of fat redistribution and protein-wasting features. The diagnosis of patients with ACTH-independent Cushing's syndrome with bilateral adrenal masses is challenging for localisation of the lesion. Both adrenal venous sampling and 131 I-NP-59 scintigraphy are good methods to use in these patients with Cushing's syndrome presenting with bilateral adrenal masses.