Autonomous nodular hyperplasia of the adrenal cortex: tertiary hypercortisolism?
Two cases of Cushing's syndrome are reported in which apparently autonomous adrenal adenomata were associated with the presence of pituitary tumours. In one case the patient was apparently cured by unilateral adrenalectomy, although she was noted to have radiological evidence of an intrasellar tumour; serum cortisol was not suppressed by dexamethasone and ACTH was undetectable. Serum ACTH in the second case was initially 31 ng/l but became undetectable during the course of investigation. Transsphenoidal removal of a corticotroph adenoma did not affect serum cortisol and she proceeded to unilateral adrenalectomy. The pathogenesis of autonomous macronodular hyperplasia is discussed, as well as the options for management.
Sturrock
N D
ND
Department of Diabetes and Endocrinology, City Hospital, Nottingham, UK.
Morgan
L
L
Jeffcoate
W J
WJ
D000236:Adenoma / Q000150:complications* / Q000000981:diagnostic imaging; D000293:Adolescent; D000302:Adrenal Cortex / Q000473:pathology*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D003480:Cushing Syndrome / Q000150:complications*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000097:blood / Q000209:etiology; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
D000324:Adrenocorticotropic Hormone