Skip to main content
Log in

Cushing's syndrome with cortisol hypersecretion from one of bilateral adrenocortical adenomas: Report of a case

  • Case Reports
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

We report herein the case of a 40-year-old man with Cushing's syndrome, diagnosed by clinical manifestations and endocrinological studies, who was found to have bilateral adrenocortical adenomas, one of which hypersecreted cortisol. The Cushing's syndrome was therefore attributed to primary adrenocortical disease, and the right adrenal tumor was resected and histologically diagnosed as a so-called black adenoma. After resection of the right tumor, the left adrenal tumor showed no signs of cortisol hypersecretion for the 23 months of follow-up until the patient died of peritonitis subsequent to the rupture of a duodenal ulcer. The left adrenal tumor was examined at autopsy and found to be a cortical adenoma. These data imply that the adrenal adenomas developed primarily from the adrenal gland itself, and that one of the tumors was well differentiated and secreted excess hormones, while the other remained in cell proliferation without hypersecretion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

References

  1. Orth DN, Liddle GW (1971) Results of treatment in 108 patients with Cushing's syndrome. New Engl J Med 285:243–247

    PubMed  Google Scholar 

  2. Demura H, Takeda R, Miyamori I, Shimizu S, Sasano N, Yasuhara S, Jibiki K, Demura R, Odagiri E, Aiba M, Suda T, Shizume K, Nomura K, Naruse M (1988) Cushing's syndrome in Japan with special reference to adrenocortical dysplasia or hyperplasia, proceedings of the open symposium of disorders of adrenal hormones. Takeda R, Miyamori I (ed) Excerpta Medica, Tokyo, pp 3–25

    Google Scholar 

  3. Hayes MA, Goldenberg IS (1961) Operative treatment of adrenal cortical hyperfunctioning diseases. Ann Surg 154(Suppl):33–44

    PubMed  Google Scholar 

  4. Chappell AG (1963) Cushing's syndrome due to bilateral adrenal adenoma. Proc R See Med 56:165–166

    Google Scholar 

  5. Mimou N, Sakato S, Nakabayashi H, Saito Z, Takeda R, Matsubara F (1985) Cushing's syndrome associated with bilateral adrenal adenomas. Acta Endocrinol 108:245–254

    PubMed  Google Scholar 

  6. Aiba M, Kawakami M, Ito Y, Fujimoto Y, Suda T, Demura H (1992) Bilateral adrenocortical adenomas causing Cushing's syndrome. Report of two cases with histochemical and ultrastructural studies and a review of the literature. Arch Pathol Lab Med 116:146–150

    PubMed  Google Scholar 

  7. Zeiger MA, Nieman LK, Cutler GB, Chrousos GP, Doppman JL, Travis WD, Norton JA (1991) Primary bilateral adrenocortical causes of Cushing's syndrome. Surgery 110:1106–1115

    PubMed  Google Scholar 

  8. Kato S, Masunaga R, Kawabe T, Nagasaka A, Miyamoto T, Itoh M, Nakai A. Iwase K, Tsujimura T, Ohtani S, Inagaki A, Miura K, Chikamatsu H, Hishida H, Mizuno Y (1992) Cushing's syndrome induced by hypersecretion of cortisol from only one of bilateral adrenocortical tumors. Metabolism 41:260–263

    PubMed  Google Scholar 

  9. Orth DN, Kovacs WJ, Debold CR (1992) The adrenal cortex. In: Wilson JD, Foster DW (eds) Williams textbook of enderinology, 8th ed. WB Saunders, Philadelphia, pp 536–562

    Google Scholar 

  10. Kirschner MA, Powell RD Jr, Lipsett MB (1964) Cushing's syndrome: Nodular cortical hyperplasia of adrenal glands with clinical and pathological features suggesting adrenocortical tumor. J Clin Endocrinol Metab 24:947–955

    PubMed  Google Scholar 

  11. Meador CK, Bowdoin B, Owen WC Jr, Farmer TA Jr (1967) Primary adrenocortical nodular dysplasia: A rare cause of Cushing's syndrome. J Clin Endocrinol Metab 27:1255–1263

    Google Scholar 

  12. Kaneko H, Ohmura Y, Hirano J, Sugano O, Kawamura S (1989) A case report of Cushing's syndrome due to adrenocortical nodular dysplasia, with remission period of 6 years after unilateral adrenalectomy. Nippon Hinyokika Gakkai Zasshi (Japanese Journal of Urology) 80:732–736

    Google Scholar 

  13. Aiba M, Hirayama A, Iri H, Ito Y, Fujimoto Y, Mabuchi G, Murai M, Tazaki H, Maruyama H, Saruta T, Suda T, Demura H (1991) Adrenocorticotropic hormone-independent bilateral adrenocortical macronodular hyperplasia as a distinct subtype of Cushing's syndrome. Enzyme histochemical and ultrastructural study of four cases with a review of the literature. Am J Clin Pathol 96:334–340

    PubMed  Google Scholar 

  14. Schteingart DE, Tsao HS (1980) Coexistence of pituitary adrenocorticotropin-dependent Cushing's syndrome with a solitary adrenal adenoma. J Clin Endocrinol Metab 50:961–966

    PubMed  Google Scholar 

  15. Rizza RA, Wahner HW, Spelsberg TC, Northcutt RC, Moses HL (1978) Visualization of nonfunctioning adrenal adenomas with iodocholesterol: Possible relationship to subcellular distribution of tracer. J Nucl Med 19:458–463

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Iwase, K., Nagasaka, A., Tsujimura, T. et al. Cushing's syndrome with cortisol hypersecretion from one of bilateral adrenocortical adenomas: Report of a case. Surg Today 24, 538–543 (1994). https://doi.org/10.1007/BF01884575

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01884575

Key Words

Navigation