title: Adrenal adenoma with bilateral adrenocortical nodular change in a patient with Cushing's syndrome.
abstract: We report a 57-year-old male patient with adrenocorticotrophin (ACTH)-independent Cushing's syndrome and long-standing hypertension. Both abdominal computed tomographic scan and magnetic resonance imaging revealed bilateral adrenal enlargement with the presence of a tumour in the left adrenal. Marked uptake of 131I-6 beta-iodomethyl-19-norcholesterol was observed only in the left adrenal gland. Left adrenalectomy and biopsy of the right adrenal gland were subsequently performed. Histological examination revealed the presence of an adrenocortical adenoma in the left adrenal with multiple adrenocortical nodules in both left and right non-neoplastic adrenals. Peri- and intraadrenal arteries and arterioles demonstrated marked arteriosclerotic vascular changes. Immunoreactivity for several steroidogenic enzymes was present in the tumour and markedly diminished in the non-neoplastic adrenals. This patient with Cushing's adenoma is considered to have developed adrenocortical nodules in the nonneoplastic adrenal possibly as a result of localized compensatory overgrowth of adrenocortical cells in response to ischaemic changes due to arteriopathy. When examining patients with Cushing's syndrome and bilateral adrenal enlargement, the possibility of concomitant adenoma and adrenocortical nodule formation should also be considered in the differential diagnosis
authors.affiliation: Department of Pathology, Tohoku University School of Medicine, Sendai, Japan. k-iino@patholo2.med.tohoku.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Iino
authors.forename: H
authors.initials: H
authors.lastname: Sasano
authors.forename: H
authors.initials: H
authors.lastname: Nagura
authors.forename: F
authors.initials: F
authors.lastname: Watanabe
authors.forename: M
authors.initials: M
authors.lastname: Iwabuchi
authors.forename: M
authors.initials: M
authors.lastname: Ozawa
authors.forename: Y
authors.initials: Y
authors.lastname: Oki
authors.forename: T
authors.initials: T
authors.lastname: Yoshimi
mesh_terms: D015096:3-Hydroxysteroid Dehydrogenases / Q000032:analysis; D000302:Adrenal Cortex / Q000201:enzymology / Q000473:pathology*; D000306:Adrenal Cortex Neoplasms / Q000150:complications* / Q000201:enzymology / Q000473:pathology; D002786:Cholesterol Side-Chain Cleavage Enzyme / Q000032:analysis; D003480:Cushing Syndrome / Q000201:enzymology / Q000209:etiology* / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000473:pathology; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D013252:Steroid 11-beta-Hydroxylase / Q000032:analysis; D013254:Steroid 17-alpha-Hydroxylase / Q000032:analysis; D013255:Steroid 21-Hydroxylase / Q000032:analysis
chemical_list: D015096:3-Hydroxysteroid Dehydrogenases; D013255:Steroid 21-Hydroxylase; D013254:Steroid 17-alpha-Hydroxylase; D013252:Steroid 11-beta-Hydroxylase; D002786:Cholesterol Side-Chain Cleavage Enzyme