[Pre-toxic adrenocortical adenoma ("pre-Cushing syndrome"): role of 17-hydroxyprogesterone dosage under ACTH analog stimulation. Apropos of a case].
We report on a case of a 63-year-old male patient who presented with an adrenal incidentaloma corresponding to a pre-toxic adrenocortical adenoma ("pre-Cushing's syndrome"). Nycthemeral cortisol cycle and free urinary cortisol were within the normal range. Basal ACTH and dehydroepiandrosterone sulfate levels were decreased and the 17-hydroxyprogesterone (17OHP) response under ACTH stimulation (tetracosactide) was increased. The ACTh test appears mandatory in the incidentaloma work-up to order to identify the pre-toxic adenomas. Its elevation reflects likely intra-tumoral enzymatic defects. Pre-Cushing's syndrome therapeutic management is still debated. No surgery was performed in our patient. A 3-year follow-up did not show overt Cushing's syndrome features.
Clinique Endocrinologique Marc Linquette, USNA, CHRU, Lille.
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Vlaeminck
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Dewailly
D019326:17-alpha-Hydroxyprogesterone / Q000097:blood*; D000306:Adrenal Cortex Neoplasms / Q000097:blood* / Q000473:pathology / Q000652:urine; D018246:Adrenocortical Adenoma / Q000097:blood* / Q000473:pathology / Q000652:urine; D003366:Cosyntropin; D003480:Cushing Syndrome / Q000175:diagnosis*; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D003937:Diagnosis, Differential; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D008297:Male; D008875:Middle Aged
D003366:Cosyntropin; D019314:Dehydroepiandrosterone Sulfate; D019326:17-alpha-Hydroxyprogesterone; D006854:Hydrocortisone