Endocrine Abstracts (2017) 49 EP831 | DOI: 10.1530/endoabs.49.EP831

ACTH-independent subclinical Cushing's syndrome in patient with acromegaly and adrenal incidentaloma

Maria Kurowska, Joanna Malicka & Jerzy Tarach

Department of Endocrinology, Medical University, Lublin, Poland.

Introduction: It is well established that acromegaly is associated with increased risk of cancer. However, it is currently unclear whether patients with acromegaly are at increased risk of developing adrenal tumors and little is known about the association between acromegaly and adrenal adenomas. The simultaneous occurrence of preclinical Cushing’s syndrome in patients with acromegaly and adrenal adenoma is extremely rare, and to our knowledge, so far only 5 such cases have been reported in literature.

Case report: 73-year-old female with typical acromegalic appearance and acromegaly suspected 34 years ago and recognized 16 years ago. She underwent non complete transsphenoidal resection of somatotroph macroadenoma 15 years ago. Since neurosurgery she is chronically treated with long-acting somatostatin analogue, currently with lanreotide autogel 120 mg every 28 days. The current GH level is 2.59 ng/ml [n:0.126–9.88] and IGF-1 252.2 ng/ml [n:29–204]. Approximately 3 years ago, a focal lesion 22×17 mm was detected in left adrenal gland, with a basal density (−)12HU (tumor density in the adrenal protocol: (+)18HU, (+)10HU, (−)1HU respectively), suggesting adenoma. The patient had long-term arterial hypertension with no cushingoid features. An examination of pituitary-adrenal axis showed lowered ACTH level=4,76 pg/ml [n:7.2–63.6], a tendency to lose a circadian rhythm of cortisol [19.6–10.3 μg/dl] and the lack of cortisol secretion inhibition by 1 and 2 mg of dexamethasone [8.5 and 5.3 μg/ml, respectively]. Daily excretion of urine cortisol was normal [172.5 and 123.6 μg; n:55.5–286.0].

Conclusion: In order to determine the incidence and the relationship between the adrenal tumors and acromegaly, standard evaluating of the adrenal glands is indicated in patients with acromegaly.

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