Possible pre-Cushing's syndrome due to an adrenal adenoma incidentally discovered.
We demonstrated the functional evaluation of adrenal incidentaloma in 8 patients who had no abnormal finding associated with Cushing's syndrome. Adrenal tumors were incidentally discovered by abdominal echogram in 5 patients and by computed tomography (CT) in 3 patients. Serum cortisol levels and urinary excretion of 17-hydroxycorticosteroids (17-OHCS) were within normal limits in four of 8 patients. Urinary excretion of free cortisol was also within normal limits except for patient 8. Urinary excretion of 17-OHCS, however, was not suppressed by dexamethasone administration in five of 8 patients. Excretion of urinary 17-OHCS did not increase in response to metyrapone in 3 of 4 dexamethasone-insuppressible patients, but increased in 3 dexamethasone-suppressible ones. Serum cortisol increased in response to exogenous ACTH in all 6 patients examined. 131I-Adosterol accumulation was found in only the tumor side in 7 patients and bilaterally in one patient. Adrenalectomy was done in 7 patients, and microscopic findings showed adrenocortical adenoma. Serum cortisol was significantly suppressed in response to dexamethasone in the post-operative stage in all 7 patients examined. These results indicate that these adrenal incidentalomas seem to have a cortisol over-production which is dexamethasone-insuppressible and ACTH-dependent, and that they can be classified as "Pre-Cushing's Syndrome."
Tsuboi
Y
Y
Department of Medicine, Jichi Medical School, Tochigi, Japan.
Ishikawa
S
S
Fujisawa
G
G
Okada
K
K
Saito
T
T
D015065:17-Hydroxycorticosteroids / Q000652:urine; D000284:Administration, Oral; D000306:Adrenal Cortex Neoplasms / Q000150:complications* / Q000378:metabolism / Q000628:therapy; D000315:Adrenalectomy; D018246:Adrenocortical Adenoma / Q000150:complications* / Q000378:metabolism / Q000628:therapy; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D003131:Combined Modality Therapy; D003480:Cushing Syndrome / Q000209:etiology* / Q000378:metabolism / Q000628:therapy; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D008297:Male; D008875:Middle Aged
D015065:17-Hydroxycorticosteroids; D005938:Glucocorticoids; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone