Endocrine Abstracts

Background: The presence of Adrenocorticotropic hormone (ACTH)-independent Cushing syndrome that is associated with androgen hypersecretion is extremely rare in benign adrenal tumors. Precise recognition and management of this association will have a great impact on the management of such patient.

Clinical case: We describe a case of a 35-year-old lady who presented with 2 years history of difficult-to-control hypertension, symptoms of androgen excess along with Cushing features. Further workup revealed lack of serum cortisol suppression after overnight 1-mg dexamethasone suppression test [493 nmol/l (17.8 μg/dl)] along with 24-h urine free cortisol of 1020 μg/24 h (reference range: 21–292 μg/24 h) and Adrenocorticotropic hormone (ACTH) level of 1.18 pmol/l (reference range: 1.03–10.70 pmol/l). Androgens profile was consistent with high Dehydroepiandrosterone (DHEA) level [22 umol/l (reference range: 2–11.1 umol/l)] and serum testosterone level was 2.18 nmol/l (reference range: 0.38–1.97 nmol/l). There was no biochemical evidence of hyperaldosteronism or pheochromocytoma. Subsequent imaging confirmed the presence of large heterogeneous left adrenal mass (4.4×7×4.6 cm) with enhancing solid and cystic/necrotic components and small round calcifications. A left robotic adrenalectomy was performed uneventfully. The histopathologic findings were consistent with the diagnosis of an adrenocortical adenoma as there were no features of malignancy seen as per modified Weis criteria. Postoperatively, the patient had undetectable cortisol level with marked improvement in her blood pressure.

Conclusion: An unusual case of adrenocortical adenoma that is associated with plurihormonal hypersecretion is described. Clinicians should be aware of such rare association when evaluating a patient with a similar context.