Preclinical Cushing's syndrome resulting from black adrenal adenoma a case report

Hiroshi Tokunaga, Nobuhiro Miyamura, Kazunari Sasaki, Kazuaki Yoshizato, Mina Itasaka, Kazuhiko Nakamaru, Mihoshi Suefuji, Junji Kawashima, Kazuya Matsumoto, Hironobu Sasano, Eiichi Araki

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)

Abstract

A 59-year-old Japanese woman, admitted for the treatment of diabetes mellitus and hypertension, was incidentally discovered to have a solid mass of 1.4 cm in diameter by CT scan with the attenuation value of 38 Hounsfield units, relatively higher for ordinary adrenal adenomas. Magnetic resonance imaging revealed no reduction of signal intensity on opposite-phase image on T1-weighted sequence. Adrenal scintigraphy imaging with 131I-adosterol did not show any uptake of the isotope in the area corresponding to both adrenals. Although she had no characteristic feature of overt Cushing's syndrome, her serum cortisol level was not suppressed after an overnight dexamethasone administration. She was diagnosed as having preclinical Cushing's syndrome. Left adrenalectomy was performed, revealing the well-circumscribed black tumor, mainly consisted of compact cell, in which cytoplasm was filled with numerous granules pigmented with dark to golden brown colors on hematoxylin-eosin staining. These findings suggested that her incidentaloma was a black adrenal adenoma. Production of steroid hormones was confirmed by immunohistochemical analysis of steroidogenic enzymes and by measurement of the tissue contents of hormones, whose levels were comparable with those in adenomas of overt Cushing's syndrome. This is the first case report of preclinical Cushing's syndrome resulting from black adrenal adenoma.

Original languageEnglish
Pages (from-to)60-66
Number of pages7
JournalHormone Research
Volume62
Issue number2
DOIs
Publication statusPublished - 2004

Keywords

  • Adrenal incidentaloma
  • Adrenal scintigraphy
  • Black adrenal adenoma
  • Immunohistochemistry
  • Preclinical Cushing's syndrome
  • Steroid content of adrenal tumor

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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