Coexistence of Cushing syndrome from functional adrenal adenoma and Addison disease from immune-mediated adrenalitis.
A 56-year-old woman presented with an incidental adrenal adenoma and physical examination findings that included moderate obesity, a slight cervicothoracic fat pad ("buffalo hump"), increased supraclavicular fat pads, and white abdominal striae. Biochemical workup revealed elevated levels of 24-hour urinary free cortisol but normal serum morning cortisol and suppressed levels of corticotropin, suggestive of adrenal-dependent Cushing syndrome. The resected adrenal gland revealed macronodular cortical hyperplasia with a dominant nodule. Other findings included an absent cortisol response to corticotropin stimulation, presence of serum anti-21-hydroxylase antibodies, and mononuclear cell infiltration--consistent with adrenalitis. The findings represent, to the authors' knowledge, the first known case of a patient with coexistent functional cortisol-secreting macronodular adrenal tumor resulting in Cushing syndrome and immune-mediated adrenalitis resulting in Addison disease.
Appalachian Rural Health Institute Diabetes/Endocrine Center, Ohio University Heritage College of Osteopathic Medicine, Castrop Center, Suite 200, Athens, OH 45701-2859, USA. rcolucci@insight.rr.com
Randall
R
Colucci
Rafael E
RE
Jimenez
William
W
Farrar
Ramiro
R
Malgor
Leonard
L
Kohn
Frank L
FL
Schwartz
D000224:Addison Disease / Q000175:diagnosis / Q000473:pathology*; D000236:Adenoma / Q000175:diagnosis / Q000473:pathology*; D000307:Adrenal Gland Diseases / Q000175:diagnosis / Q000473:pathology; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000473:pathology*; D000311:Adrenal Glands / Q000473:pathology; D000324:Adrenocorticotropic Hormone / Q000652:urine; D002395:Catecholamines / Q000652:urine; D015897:Comorbidity; D003480:Cushing Syndrome / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D033162:Incidental Findings; D008875:Middle Aged
D002395:Catecholamines; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone