A case of preclinical Cushing's syndrome associated with diurnal rhythms of ACTH and cortisol in blood: correlation with histological findings.
We describe a case of adrenocortical adenoma with preclinical Cushing's syndrome demonstrating diurnal rhythms of ACTH and cortisol in blood. A 50-year-old man was admitted to the hospital for the evaluation of incidental right adrenal mass with hyperglycemia and hypertension. On admission, there were no signs of clinical manifestation of hypercortisolism. The basal levels of cortisol (9.3 microg/dl) and ACTH (9.4 pg/ml) at 0800 h were not elevated and these diurnal rhythms were maintained. One or 8 mg of dexamethasone given orally overnight suppressed the plasma ACTH but not serum cortisol. Ultrasonogram, CT and scintiscan of (131)I adosterol all demonstrated an enlarged adrenal mass in the right adrenal gland. The right adrenal gland was subsequently resected by laparoscopic surgery. Histopathological findings of resected adrenal tumor were consistent with adrenocortical adenoma. Adjacent non-neoplastic adrenal tissue demonstrated adrenocortical atrophy but DHEA-sulfotransferase immunoreactivity in the zona reticularis was detected.
Ikarashi
Tomoo
T
Department of Internal Medicine, Division of Endocrine and Metabolism, Nagaoka Red Cross Hospital, Nagaoka, Niigata, Japan.
Kamoi
Kyuzi
K
Asakawa
Katsuaki
K
Tanaka
Midori
M
Miyakoshi
Masashi
M
Komeyama
Takeshi
T
Morishita
Hideo
H
Usuda
Hiroyuki
H
Emura
Iwao
I
Sasano
Hironobu
H
D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000175:diagnosis / Q000473:pathology; D000311:Adrenal Glands / Q000473:pathology; D018246:Adrenocortical Adenoma / Q000097:blood / Q000175:diagnosis / Q000473:pathology; D000324:Adrenocorticotropic Hormone / Q000097:blood*; D002940:Circadian Rhythm; D003480:Cushing Syndrome / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged
D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone