title: An unusual variant of Cushing syndrome.
abstract: OBJECTIVE
  To discuss the initial clinical manifestations of primary pigmented nodular adrenocortical disease.
  
  
  METHODS
  We present a case report of a 4-year-old boy who had the classic clinical features of Cushing syndrome. Results of hormonal investigations are reviewed, and histopathologic findings are illustrated.
  
  
  RESULTS
  Investigations revealed adrenocorticotropic hormone (corticotropin)-independent Cushing syndrome. Findings on magnetic resonance imaging of the pituitary gland and abdomen were within normal limits. The patient underwent bilateral adrenalectomy. The histopathologic features were consistent with primary pigmented nodular adrenocortical disease.
  
  
  CONCLUSIONS
  Primary pigmented nodular adrenocortical disease should be suspected in patients with corticotropin-independent Cushing syndrome who have normal findings on adrenal imaging.
authors.affiliation: Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Hosahithlu K
authors.initials: HK
authors.lastname: Ganesh
authors.forename: Joe
authors.initials: J
authors.lastname: George
authors.forename: Mavila V
authors.initials: MV
authors.lastname: Vimal
authors.forename: Tushar
authors.initials: T
authors.lastname: Bandgar
authors.forename: Padma S
authors.initials: PS
authors.lastname: Menon
authors.forename: Nalini S
authors.initials: NS
authors.lastname: Shah
mesh_terms: D000303:Adrenal Cortex Diseases / Q000175:diagnosis* / Q000473:pathology; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D002675:Child, Preschool; D003480:Cushing Syndrome / Q000150:complications* / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010902:Pituitary Gland / Q000473:pathology
chemical_list: D000324:Adrenocorticotropic Hormone