J Korean Surg Soc.  1998 Nov;55(5):769-774.

A Case of Bilateral Adrenal Cortical Adenomas Causing Cushing's Syndrome and Primary Aldosteronism

• Choi SE
• Kim YC
• Noh DY
• Youn YK
• Oh SK

Abstract

A 38-year old female was admitted to our hospital for further evaluation of an incidentally found cardiac murmur. She had been in a hypertensive state for 5 years but had taken antihypertensive drugs intermittently on her own. Her history revealed that she had become amenorrheic for 7 months and had, had headaches for a few months. Physical examination revealed central obesity and a moon face, but no hirsuitism. When she first visited our hospital, her blood pressure was 260/170 mmHg and grade 2 systolic murmur was audible along the left sternal border. Laboratory studies revealed high levels of 24-hour urine-free cortisol and plasma aldosterone, but a very low level of plasma adrenocorticotropic hormone and plasma renin activity. A low-dose and a high-dose dexamethasone suppression tests, adrenal venous sampling, inferior petrosal sinus sampling, and a renin stimulation test were performed. Bilateral adrenal masses were found on computerized tomographic scanning and magnetic resonance imaging but there was no abnormality of the pituitary gland. The uncontrollable blood pressure and the elevated 24-hour urine-free cortisol and plasma aldosterone levels were corrected by a right-total and left-subtotal adrenalectomy. Pathologic findings were bilateral adrenal cortical adenomas of different cell types. These findings indicate that the adrenal cortical adenomas were tumors that functioned differently, causing Cushing's syndrome and primary aldosteronism in the same patient. A review of, the literature published in English showed that this is the first reported case, of bilateral adrenal adenomas functioning differently.

Keyword

Bilateral adrenal cortical adenoma; Cushing's syndrome; Primary aldosteronism

MeSH Terms

Adenoma
Adrenalectomy
Adrenocortical Adenoma*
Adrenocorticotropic Hormone
Adult
Aldosterone
Antihypertensive Agents
Blood Pressure
Cushing Syndrome*
Dexamethasone
Female
Headache
Heart Murmurs
Humans
Hydrocortisone
Hyperaldosteronism*
Magnetic Resonance Imaging
Obesity, Abdominal
Petrosal Sinus Sampling
Physical Examination
Pituitary Gland
Plasma
Renin
Systolic Murmurs
Adrenocorticotropic Hormone
Aldosterone
Antihypertensive Agents
Dexamethasone
Hydrocortisone
Renin