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Adrenocorticotropin-Independent Bilateral Macronodular Adrenal Hyperplasia: An Unusual Cause of Cushing’s Syndrome*
- Source :
- The Journal of Clinical Endocrinology & Metabolism. 68:855-860
- Publication Year :
- 1989
- Publisher :
- The Endocrine Society, 1989.
-
Abstract
- Inappropriate ACTH secretion with bilateral diffuse or macronodular adrenal hyperplasia is the most common cause of Cushing's syndrome. This report describes a patient with Cushing's syndrome and feminization due to ACTH-independent bilateral macronodular adrenal hyperplasia. A 47-yr-old black man presented with Cushingoid features, diabetes mellitus, hypertension, impotence, and gynecomastia. Urinary cortisol and 17-hydroxycorticosteroid excretion were 94 nmol/mmol creatinine (normal, less than 32) and 5.8 mumol/mmol creatinine (normal, 0.6-3.6), respectively. Both decreased by less than 30% after administration of dexamethasone (8 and 16 mg/day), and urinary 17-hydroxycorticosteroid excretion did not increase after metyrapone (750 mg, orally, every 4 h for six doses). Plasma ACTH was undetectable (less than 1 pmol/L) and was not stimulated by administration of metyrapone or ovine CRH. Serum testosterone was 5.2 nmol/L (normal, 7-30), FSH was 5 U/L (normal, 3-18), LH was 2.8 U/L (normal, 1.5-9.2), and estrone was 767 pmol/L (normal, 55-240). Both adrenal glands were enlarged, with a total weight of 86 g (normal, 8-10), and contained multiple nodules (diameter, greater than 0.5 cm) composed of two active cell types, one of which was also observed between the nodules. Cushing's syndrome with feminization due to ACTH-independent bilateral macronodular adrenal hyperplasia is an unusual process of unknown etiology that should be included with the other known causes of Cushing's syndrome.
- Subjects :
- Male
medicine.medical_specialty
Hydrocortisone
Estrone
Endocrinology, Diabetes and Metabolism
medicine.medical_treatment
Clinical Biochemistry
Cushingoid
Biochemistry
Dexamethasone
Cushing syndrome
Endocrinology
Adrenocorticotropic Hormone
Internal medicine
Adrenal Glands
Humans
Medicine
Feminization
Testosterone
Cushing Syndrome
Adrenal Hyperplasia, Congenital
Metyrapone
business.industry
Adrenalectomy
Biochemistry (medical)
Middle Aged
medicine.disease
Gynecomastia
Macronodular Adrenal Hyperplasia
business
hormones, hormone substitutes, and hormone antagonists
medicine.drug
Subjects
Details
- ISSN :
- 19457197 and 0021972X
- Volume :
- 68
- Database :
- OpenAIRE
- Journal :
- The Journal of Clinical Endocrinology & Metabolism
- Accession number :
- edsair.doi.dedup.....9e1119f14e4743a416ed03f85d8de515