Pre-Cushing's syndrome not recognized by conventional dexamethasone suppression-tests in an adrenal "incidentaloma" patient.
Pre-Cushing's syndrome has been recently diagnosed in 6-12% of patients affected with incidentally discovered adrenal masses. Some of these patients have been described to show transient hypoadrenalism after surgery, similarly to those affected with overt Cushing's syndrome. We studied a 70-year-old male patient with a large left adrenal mass, incidentally discovered, who displayed 24-h urinary free cortisol levels at the upper limit of the normal range, normal dexamethasone overnight and low-dose suppression tests and not suppressed ACTH levels, increased 17-hydroxyprogesterone response to ACTH stimulation and low upright plasma renin activity with normal serum aldosterone levels; furthermore, DHEAS level was low and 75 Selenium-cholesterol scintigraphy showed unilateral uptake concordant with the side of the mass. Soon after left adrenalectomy, he complained of acute hypoadrenalism requiring cortisol replacement therapy: ten months after surgery he is still hypoadrenal. Moreover, stimulated 17-hydroxyprogesterone and plasma renin activity in clino- and orthostatic posture have become normal. We propose that conventional dexamethasone suppression-tests may be not enough sensitive in this kind of patients and that in selected cases the absence of controlateral uptake at scintigraphy may be more reliable in predicting post-surgical hypoadrenalism.
Torlontano
M
M
Division of Endocrinology, Ospedale Casa Sollievo della Sofferenza IRCCS, S. Giovanni Rotondo (FG), Italy.
Zingrillo
M
M
D'Aloiso
L
L
Ghiggi
M R
MR
Di Cerbo
A
A
Scillitani
A
A
Petracca-Ciavarella
G
G
Liuzzi
A
A
D000236:Adenoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D000368:Aged; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000209:etiology; D003907:Dexamethasone; D005938:Glucocorticoids; D006728:Hormones / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis; D011877:Radionuclide Imaging
D005938:Glucocorticoids; D006728:Hormones; D003907:Dexamethasone; D006854:Hydrocortisone