title: Adrenal Cushing syndrome with detectable ACTH from an unexpected source.
abstract: Mixed corticomedullary adrenal tumours (MCMT) are rare. We describe the second reported case of a male patient presenting with hypertension and Cushing syndrome with MCMT. A man aged 48 years presented with hypertension and signs of Cushing syndrome. 24-hour urine cortisol was elevated, with detectable adrenocorticotropic hormone (ACTH). A high-dose dexamethasone suppression test indicated an adrenal or ectopic Cushing syndrome. Plasma metanephrines were normal. A 3 cm left adrenal mass was identified without potential ectopic sources of ACTH on imaging. After induction of anaesthesia for laparoscopic adrenalectomy, the patient developed resistant hypertension with stress-dose hydrocortisone administration. Surgery was cancelled and repeat testing revealed elevated plasma metanephrines. α-Blockade was administered for a presumed coexisting pheochromocytoma, and the patient underwent adrenalectomy. Pathology revealed an MCMT. This case highlights the importance of a thorough biochemical evaluation in patients with adrenal masses to rule out multiple hormone producing tumours.
authors.affiliation: Department of Surgery, Mount Sinai Beth Israel, New York, New York, USA.
authors.forename: Thinzar M
authors.identifier: http://orcid.org/0000-0003-1820-088X
authors.initials: TM
authors.lastname: Lwin
authors.affiliation: Department of Internal Medicine, Mount Sinai Queens, Long Island City, New York, USA.
authors.forename: Nehal
authors.initials: N
authors.lastname: Galal
authors.affiliation: Department of Pathology, NYU Langone Medical Center, New York, New York, USA.
authors.forename: Shweta
authors.initials: S
authors.lastname: Gera
authors.affiliation: Department of Endocrine Surgery, Weill Cornell Medicine-NYP/Lower Manhattan Hospital, New York, New York, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Marti
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000652:urine; D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000652:urine; D000313:Adrenal Medulla; D000324:Adrenocorticotropic Hormone / Q000652:urine*; D003480:Cushing Syndrome / Q000209:etiology* / Q000652:urine; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D006973:Hypertension / Q000209:etiology* / Q000652:urine; D008297:Male; D008875:Middle Aged
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone