title: Preclinical Cushing's syndrome resulting from black adrenal adenoma. A case report.
abstract: A 59-year-old Japanese woman, admitted for the treatment of diabetes mellitus and hypertension, was incidentally discovered to have a solid mass of 1.4 cm in diameter by CT scan with the attenuation value of 38 Hounsfield units, relatively higher for ordinary adrenal adenomas. Magnetic resonance imaging revealed no reduction of signal intensity on opposite-phase image on T1-weighted sequence. Adrenal scintigraphy imaging with 131I-adosterol did not show any uptake of the isotope in the area corresponding to both adrenals. Although she had no characteristic feature of overt Cushing's syndrome, her serum cortisol level was not suppressed after an overnight dexamethasone administration. She was diagnosed as having preclinical Cushing's syndrome. Left adrenalectomy was performed, revealing the well-circumscribed black tumor, mainly consisted of compact cell, in which cytoplasm was filled with numerous granules pigmented with dark to golden brown colors on hematoxylin-eosin staining. These findings suggested that her incidentaloma was a black adrenal adenoma. Production of steroid hormones was confirmed by immunohistochemical analysis of steroidogenic enzymes and by measurement of the tissue contents of hormones, whose levels were comparable with those in adenomas of overt Cushing's syndrome. This is the first case report of preclinical Cushing's syndrome resulting from black adrenal adenoma.
authors.affiliation: Department of Metabolic Medicine, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tokunagaa
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Miyamura
authors.forename: Kazunari
authors.initials: K
authors.lastname: Sasaki
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Yoshizato
authors.forename: Mina
authors.initials: M
authors.lastname: Itasaka
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakamaru
authors.forename: Mihoshi
authors.initials: M
authors.lastname: Suefuji
authors.forename: Junji
authors.initials: J
authors.lastname: Kawashima
authors.forename: Kazuya
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sasano
authors.forename: Eiichi
authors.initials: E
authors.lastname: Araki
mesh_terms: D015065:17-Hydroxycorticosteroids / Q000097:blood; D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D018246:Adrenocortical Adenoma / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000450:Aldosterone / Q000097:blood; D003480:Cushing Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
chemical_list: D015065:17-Hydroxycorticosteroids; D000450:Aldosterone; D019314:Dehydroepiandrosterone Sulfate; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone