Endocrine Abstracts

Cushing’s syndrome can occur as a consequence of prolonged exposure to excessive amounts of circulating free cortisol and the various causes can be broken down into exogenous causes, such as from steroid treatment for chronic illnesses, or endogenous as in this case. Cushing’s syndrome can be further classified into ACTH-dependent and ACTH-independent1, for which the latter accounts for 15–20% of all cases. This report highlights the case of a 35 year old female patient who presented with Cushing’s syndrome, the symptoms of which were concomitant with pregnancy, unmasked following delivery. She was found to have an ACTH-independent adrenal adenoma found incidentally during the workup for a pulmonary embolism following delivery via Caesarean section. Biochemical testing indicated cortisol excess and CT-adrenal scanning confirmed the presence of a tumour that kept in with an adrenal adenoma. Her case was discussed in our local MDT meeting and she was subsequently referred for laparoscopic adrenalectomy following which she had complete resolution of her symptoms.

References: 1. Newell-Price J, Bertagna X, Grossman AB & Nieman LK 2006 Cushing’s syndrome. Lancet 367 1605–1617. (doi:10.1016/S0140-6736(06)68699-6).

2. Olsson CA, Krane RJ, Klugo RC, et al. Adrenal myelolipoma. Surgery 1973;73:665–70.

3. Han M, Burnett AL, Fishman EK, et al. The natural history and treatment of adrenal myelolipoma. J Urol 1997;157:1213–6.

4. Musante F, Derchi LE, Bazzocchi M, et al. MR imaging of adrenal myelolipomas. J Comput Assist Tomogr 1991;15:111–4.

5. Terzolo M, Stigliano A, Chiodini I, Loli P, Furlani L, Arnaldi G, Reimondo G, Pia A, Toscano V, Zini M et al 2011 AME position statement on adrenal incidentaloma. European Journal of Endocrinology 164 851–870.