title: Primary pigmented nodular adrenocortical disease presenting with a unilateral adrenocortical nodule treated with bilateral laparoscopic adrenalectomy: a case report.
abstract: BACKGROUND
  Primary pigmented nodular adrenocortical disease is a rare cause of adrenocorticotropic hormone-independent Cushing's syndrome. We report an uncommon primary pigmented nodular adrenocortical disease case presenting with a unilateral adrenocortical nodule and provide a brief overview of the existing literature.
  
  
  METHODS
  A 27-year-old Caucasian woman was admitted to our Department with adrenocorticotropic hormone-independent Cushing's syndrome. Its cause was initially considered a left adrenocortical adenoma based on computer tomography imaging. The patient underwent left laparoscopic adrenalectomy and histological examination revealed pigmented micronodular adrenal hyperplasia. Evaluation for the presence of Carney complex was negative. Six months later recurrence of hypercortisolism was documented and a right laparoscopic adrenalectomy was performed further establishing the diagnosis of primary pigmented nodular adrenocortical disease. After a nine-year follow-up there is no evidence of residual disease.
  
  
  CONCLUSIONS
  Even though primary pigmented nodular adrenocortical disease is a rare cause of Cushing's syndrome, it should be included in the differential diagnosis of adrenocorticotropic hormone-independent Cushing's syndrome, especially because adrenal imaging can be misleading mimicking other adrenocortical diseases. Bilateral laparoscopic adrenalectomy is the preferred treatment in these subjects.
authors.affiliation: Department of Endocrinology and Diabetes Center, Athens General Hospital "G, Gennimatas", Athens, Greece. dorispappas@hotmail.com.
authors.forename: George N
authors.initials: GN
authors.lastname: Zografos
authors.forename: Theodora
authors.initials: T
authors.lastname: Pappa
authors.forename: Spiros
authors.initials: S
authors.lastname: Avlonitis
authors.forename: Athina
authors.initials: A
authors.lastname: Markou
authors.forename: Dimosthenis T
authors.initials: DT
authors.lastname: Chrysikos
authors.forename: Gregory
authors.initials: G
authors.lastname: Kaltsas
authors.forename: Chrysanthi
authors.initials: C
authors.lastname: Aggeli
authors.forename: George
authors.initials: G
authors.lastname: Piaditis