title: Virilizing adrenocortical adenoma with Cushing's syndrome, thyroid papillary carcinoma and hypergastrinemia in a middle-aged woman.
abstract: We report a rare case of virilizing adrenocortical adenoma complicated with Cushing's syndrome, thyroid papillary carcinoma and hypergastrinemia. A 45-year-old woman had a history of amenorrhea for 10 years, hypertension for 8 years, and diabetes mellitus for 3 years. Physical examination showed a masculinized woman with severe hirsutism, male-like baldness, deep voice, acne in the precordia, and clitorism. Plasma testosterone, DHEA-S and urinary 17-KS were high, and plasma cortisol level was it at the upper limit of the normal range, but it did not show a diurnal rhythm nor was suppressed by 2 and 8 mg of dexamethasone. Abdominal CT scan showed a left adrenal tumor (4.5 cm in size). Adrenal scintigram revealed uptake of the tracer on the left side, and plasma cortisol concentration was high in a blood sample from the left adrenal vein. Left adrenalectomy was performed. Histopathological features of resected adrenal tumor were consistent with those of adrenocortical adenoma, consisting of tumor cells with eosinophilic compact cytoplasm. Immunohistochemical staining for steroidogenic enzymes showed reactivity for P450sec, 3 beta-HSD, P450c17, P450c21 and P450c11. Plasma testosterone and cortisol levels decreased to the normal range postoperatively. The patient was also found to have a papillary thyroid carcinoma and hypergastrinemia. Our patient is a rare case of virilizing adrenocortical adenoma associated with Cushing's syndrome, thyroid papillary carcinoma, and hypergastrinemia.
authors.affiliation: First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, School of Medicine, Kitakyushu 807-8555, Japan.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Fukushima
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Okada
authors.forename: Takahisa
authors.initials: T
authors.lastname: Tanikawa
authors.forename: Chie
authors.initials: C
authors.lastname: Kawahara
authors.forename: Haruo
authors.initials: H
authors.lastname: Misawa
authors.forename: Kazuko
authors.initials: K
authors.lastname: Kanda
authors.forename: Emiko
authors.initials: E
authors.lastname: Morita
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sasano
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D000315:Adrenalectomy; D018246:Adrenocortical Adenoma / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D000792:Angiography; D002291:Carcinoma, Papillary / Q000150:complications* / Q000473:pathology; D003480:Cushing Syndrome / Q000209:etiology*; D005260:Female; D005755:Gastrins / Q000097:blood*; D006801:Humans; D008875:Middle Aged; D009377:Multiple Endocrine Neoplasia / Q000175:diagnosis; D011877:Radionuclide Imaging; D013964:Thyroid Neoplasms / Q000150:complications* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014770:Virilism / Q000209:etiology* / Q000473:pathology
chemical_list: D005755:Gastrins