title: Clinical and endocrinological features of adrenocorticotropic hormone- independent bilateral macronodular adrenocortical hyperplasia.
abstract: OBJECTIVE
  We report clinical findings in 5 patients with adrenocorticotropic hormone independent bilateral macronodular adrenocortical hyperplasia.
  
  
  METHODS
  In 4 males and 1 female 32 to 61 years old (median age 50) we evaluated clinical symptoms, endocrinological and radiological characteristics, treatment modality and postoperative clinical course.
  
  
  RESULTS
  All cases presented with some features of Cushing's syndrome. Endocrinological examination revealed autonomous adrenal cortisol production with suppressed adrenocorticotropic hormone and a loss in the diurnal circadian rhythm of plasma cortisol. Abdominal computerized tomography showed bilateral enlargement of the adrenal glands with multiple nodules. 131Iodine labeled adosterol scintigraphy demonstrated remarkable bilateral uptake by the adrenal glands. The pituitary gland appeared normal on magnetic resonance imaging. Open unilateral complete adrenalectomy and contralateral partial adrenalectomy were performed in patient 1, open bilateral complete adrenalectomy was done in patients 2 and 3, and 2 and 1-stage laparoscopic bilateral complete adrenalectomy was performed in patients 4 and 5. Single removed adrenal glands weighed 32 to 108 gm. (median 60). The histological diagnosis was macronodular adrenocortical hyperplasia in all cases. Postoperative followup was 3 to 90 months. Clinical symptoms of Cushing's syndrome disappeared or improved after surgery in all cases.
  
  
  CONCLUSIONS
  Although adrenocorticotropic hormone independent bilateral macronodular adrenocortical hyperplasia is a rare form of Cushing's syndrome, physicians are advised to consider it when diagnosing and treating cases of Cushing's syndrome with enlarged bilateral adrenal glands. Bilateral complete adrenalectomy is currently recommended as the treatment of choice.
authors.affiliation: Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Shinojima
authors.forename: H
authors.initials: H
authors.lastname: Kakizaki
authors.forename: T
authors.initials: T
authors.lastname: Usuki
authors.forename: T
authors.initials: T
authors.lastname: Harabayashi
authors.forename: K
authors.initials: K
authors.lastname: Ameda
authors.forename: T
authors.initials: T
authors.lastname: Koyanagi
mesh_terms: D000311:Adrenal Glands / Q000000981:diagnostic imaging; D000315:Adrenalectomy; D000328:Adult; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D014057:Tomography, X-Ray Computed