BILATERAL ADRENOCORTICAL ADENOMAS CAUSING CUSHING'S SYNDROME

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We report a rare case of Cushing's syndrome due to bilateral adrenocortical adenomas in a 46-year-old Japanese woman who suffered from diabetes mellitus and hypertension for several years. The patient was admitted to the hospital because of an evaluation for Cushing's syndrome. Physical examination revealed a moderately obese woman with a round face, truncal obesity and a buffalo hump. The serum cortisol was elevated with loss of the diurnal rhythm, and the urinary excretion of free cortisol was high. The plasma level of ACTH was undetectable. The plasma DHEA-sulfate was low. Cortisol and its metabolites were nonsuppressible with a high dose of dexamethasone. Plasma cortisol and ACTH did not respond to the administration of metyrapone or human CRH. The plasma cortisol responded well to synthetic ACTH. The laboratory data were consistent with ACTH-independent Cushing's syndrome. Abdominal computed tomography revealed bilateral round-shaped adrenal masses (right mass, 3 cm ; left mass, 1 cm) . Abdominal MRI revealed similar findings. An iodecholesterol scintigram showed bilateral adrenal gland activities. A presumptive diagnosis of bilateral adrenocortical adenomas was made. The patient underwent bilateral adrenalectomy. The right and left tumors was encapsulated and consisted mainly of compact cells and clear cells, respectively, while the surrounding cortexes were atrophic. Immunohistochemical analysis of the following steridogenic enzymes was performed ; P450scc, 3 β HSD, P450c21, <I>et al</I>. Immunoreactivity of all the enzymes was intense in cells of both right and left adrenocorical adenomas, while it was negative in the surrounding cortexes.

BILATERAL ADRENOCORTICAL ADENOMAS CAUSING CUSHING'S SYNDROME

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