[Adrenocortical macronodular hyperplasia with massive enlargement of the gland. A rare variant of autonomous hypercortisolism].
OBJECTIVE
To present a case of Cushing's syndrome due to massive adrenocortical macronodular hyperplasia that gave the gland the appearance of a pseudotumor.


METHODS
In a review of the surgical pathology of the adrenal gland recently performed in our hospital, 82 adrenalectomy specimens obtained from 1978-1998 were found. Of these 82 surgical specimens, 44 (53.6%) were cortical pathologies and 10 of these (12.1%) were hyperplasia. There was only one with massive adrenocortical macronodular hyperplasia. A 53-year-old male, chronic alcoholic with cushingoid obesity and hypercortisolism is described.


RESULTS
Ultrasound and CT assessment showed enlarged, asymmetrical adrenal glands and macronodules. The analytical and MRI study of the sella turcica showed primary adrenal hypercortisolism. Adrenalectomy of the dominant gland (the left adrenal whose activity was demonstrated on the 131Iodine scintiscan) was performed. The postoperative cortisol levels returned to normal and remain normal up to the present time, 18 months after surgery. The surgical specimen weighed 104 gms and was completely macronodular.


CONCLUSIONS
Massive adrenocortical macronodular hyperplasia is a rare cause of pituitary-independent autonomous primary adrenal hypercortisolism. It is always bilateral. Adrenal weight is significantly increased (total weight of both adrenals 60-180 gms) and present yellow or golden, non-encapsulated nodules of a few millimeters to up to 4 cms, comprised of cells with scanty activity, therefore massive enlargement of the glands is necessary to produce Cushing's syndrome. The clinical, biochemical and surgical aspects can cause confusion and can be suggestive of an adrenocortical neoplasm. Treatment is by adrenalectomy.
Redondo
E
E
Servicio de Anatomía Patológica, Hospital de Gran Canaria Dr. Negrín, Barranco de la Ballena s/n 35020 Las Palmas, España. arey@correo.hpino.rcanaria.es
Rey
A
A
Rivero
L
L
Sánchez-Moro
V
V
Marín
J
J
Rivero
J C
JC
Sánchez-Lobo
V
V
D000302:Adrenal Cortex / Q000473:pathology*; D000307:Adrenal Gland Diseases / Q000175:diagnosis / Q000209:etiology*; D000308:Adrenocortical Hyperfunction / Q000175:diagnosis; D003480:Cushing Syndrome / Q000150:complications; D003937:Diagnosis, Differential; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged