Nodular hyperplasia of the adrenal as a cause of Cushings syndrome is rare. Adrenal tumors, frequently causing syndromes such as hyperaldosteronism due to autonomous hormone secretion, have been described in patients with renal cysts. The aim was to describe the case of a female patient with diffuse adrenal hyperplasia, subclinical Cushings syndrome and renal cysts.
A female patient aged 69 years presented with hyperplasia of the right adrenal cortex. In computer tomography evaluation a mass measuring 2 cm was observed in the right adrenal. ACTH was 9 pg/ml, serum cortisol 16.5 μg/dl and a dexamethasone suppression test with 0.5×4×2 mg dexamethasone was abnormal serum cortisol being 4 μg/dl after the test. Renin and aldosterone were 16 and 184 pg/ml respectively, in the supine position and 22 and 548 pg/ml respectively in the standing position. The mass was surgically excised and histology showed diffuse hyperplasia of all zones of the adrenal cortex, hyperplasia of the fasciculata zone being more prominent. In a subsequent evaluation, a year later, the dexamethasone suppression test with 0.5×4×2 mg dexamethasone remained mildly abnormal, serum cortisol being 2.1 μg/dl after the test. The patient had renal cysts in the right kidney.
In conclusion, an extremely rare case of a patient with diffuse hyperplasia of all zones of the adrenal, subclinical Cushings syndrome and renal cysts is described. Renal cysts have been observed in patients with hyperaldosteronism and adrenal tumors. The case described is interesting as it is characterized by subclinical Cushings syndrome, hyperplasia of all zones of the adrenal cortex and functional hyperaldosteronism.
30 Apr - 04 May 2011
European Society of Endocrinology