Adrenal adenoma with bilateral adrenocortical nodular change in a patient with Cushing's syndrome

Kazumi Iino, Hironobu Sasano, Hiroshi Nagura, Fumie Watanabe, Masayasu Iwabuchi, Magumi Ozawa, Yutaka Oki, Teruya Yoshimi

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We report a 57-year-old male patient with adrenocorticotrophin (ACTH)- independent Cushing's syndrome and long-standing hypertension. Both abdominal computed tomographic scan and magnetic resonance imaging revealed bilateral adrenal enlargement with the presence of a tumour in the left adrenal. Marked uptake of 131-6β-iodomethyl-19-norcholesterol was observed only in the left adrenal gland. Left adrenalectomy and biopsy of the right adrenal gland were subsequently performed. Histological examination revealed the presence of an adrenocortical adenoma in the left adrenal with multiple adrenocortical nodules in both left and right non-neoplastic adrenals. Peri- and intraadrenal arteries and arterioles demonstrated marked arteriosclerotic vascular changes. Immunoreactivity for several steroidogenic enzymes was present in the tumour and markedly diminished in the non-neoplastic adrenals. This patient with Cushing's adenoma is considered to have developed adrenocortical nodules in the non-neoplastic adrenal possibly as a result of localized compensatory overgrowth of adrenocortical cells in response to ischaemic changes due to arteriopathy. When examining patients with Cushing's syndrome and bilateral adrenal enlargement, the possibility of concomitant adenoma and adrenocortical nodule formation should also be considered in the differential diagnosis.

Original languageEnglish
Pages (from-to)371-375
Number of pages5
JournalClinical Endocrinology
Issue number3
Publication statusPublished - 1997

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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