title: A case of preclinical Cushing's syndrome associated with diurnal rhythms of ACTH and cortisol in blood: correlation with histological findings.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Division of Endocrine and Metabolism, Nagaoka Red Cross Hospital, Nagaoka, Niigata, Japan.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Ikarashi
authors.forename: Kyuzi
authors.initials: K
authors.lastname: Kamoi
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Asakawa
authors.forename: Midori
authors.initials: M
authors.lastname: Tanaka
authors.forename: Masashi
authors.initials: M
authors.lastname: Miyakoshi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Komeyama
authors.forename: Hideo
authors.initials: H
authors.lastname: Morishita
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Usuda
authors.forename: Iwao
authors.initials: I
authors.lastname: Emura
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sasano
mesh_terms: 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
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone