title: Unravelling the mystery in a case of persistent ACTH-independent Cushing's syndrome.
abstract: BACKGROUND
  We present a rare variety of adrenocorticotrophic hormone (ACTH)-independent Cushing's syndrome known as primary pigmented nodular adrenocortical disease (PPNAD).
  
  
  METHODS
  The patient initially underwent unilateral adrenalectomy for what was thought to be a left adrenal adenoma.
  
  
  RESULTS
  Partial resolution of symptoms and demonstrable persistent hypercortisolism after surgery prompted further evaluation with findings leading to the diagnosis of Carney complex. A review of the adrenal histology was consistent with PPNAD.
  
  
  CONCLUSIONS
  This entity of PPNAD, which has rarely been reported in Asians, forms part of the Carney complex. The diagnosis may not be simple and straightforward, as illustrated in this patient.
authors.affiliation: Department of Medicine, Alexandra Hospital, Singapore.
authors.forename: Ling Choo
authors.initials: LC
authors.lastname: Lim
authors.forename: Leonard H C
authors.initials: LH
authors.lastname: Tan
authors.forename: C
authors.initials: C
authors.lastname: Rajasoorya
mesh_terms: D000311:Adrenal Glands / Q000000981:diagnostic imaging; D000315:Adrenalectomy; D000308:Adrenocortical Hyperfunction / Q000503:physiopathology; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000328:Adult; D015519:Bone Density; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D006801:Humans; D014057:Tomography, X-Ray Computed
chemical_list: D000324:Adrenocorticotropic Hormone