title: Functioning adrenal black adenoma with pulmonary and cutaneous cryptococcosis: a case report and review of English literature.
abstract: A 53-year-old woman experienced progressive general weakness and lumbago in the 2 years prior to a physical examination which disclosed cushingoid manifestations and a skin ulcer on the back of her right knee joint. Her plasma cortisol concentration ranged from 24.7 to 31.1 microg/dl, with an ACTH level <5 pg/ml. Urinary excretions of 17-hydroxycorticosteroid (17-OHCS) and 17-ketosteroid (17-KS) were 20.5 mg/day and 5.1 mg/day, respectively, and urinary cortisol was also increased (421 microg/day). Cortisol was not suppressed after the administration of 8 mg dexamethasone. Abdominal ultrasound sonography, computed tomography (CT) scan, and magnetic resonance imaging (MRI) studies demonstrated a left adrenal tumor and further, a chest X-ray examination showed a cavitary lesion containing a fungus ball-like mass in the left lower lung field. The serum cryptococcal antigen titer was positive at 1:128 and a bronchoalveolar lavage fluid culture yielded a growth of Cryptococcus neoformans. A biopsy specimen of the skin ulcer also suggested cryptococcosis. As a result, a left adrenectomy was performed, and the excised specimen was shown to be an adenoma consisting of compact cells with abundant pigmentation (black adenoma). A diagnosis of functioning black adenoma of the adrenal gland, complicated with pulmonary and cutaneous cryptococcosis was made.
authors.affiliation: Third Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Takahashi
authors.forename: H
authors.initials: H
authors.lastname: Iijima
authors.forename: Y
authors.initials: Y
authors.lastname: Moriwaki
authors.forename: T
authors.initials: T
authors.lastname: Yamamoto
authors.forename: S
authors.initials: S
authors.lastname: Matsuoka
authors.forename: Z
authors.initials: Z
authors.lastname: Tsutsumi
authors.forename: M
authors.initials: M
authors.lastname: Nojima
authors.forename: A
authors.initials: A
authors.lastname: Kubota
authors.forename: T
authors.initials: T
authors.lastname: Hada
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000382:microbiology*; D018246:Adrenocortical Adenoma / Q000382:microbiology*; D003453:Cryptococcosis / Q000150:complications*; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000150:complications*; D008875:Middle Aged; D012874:Skin Diseases, Infectious / Q000150:complications*