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CASE REPORT
Adrenal Cushing syndrome with detectable ACTH from an unexpected source
  1. Thinzar M Lwin1,
  2. Nehal Galal2,
  3. Shweta Gera3,
  4. Jennifer L Marti4
  1. 1Department of Surgery, Mount Sinai Beth Israel, New York, New York, USA
  2. 2Department of Internal Medicine, Mount Sinai Queens, Long Island City, New York, USA
  3. 3Department of Pathology, NYU Langone Medical Center, New York, New York, USA
  4. 4Department of Endocrine Surgery, Weill Cornell Medicine-NYP/Lower Manhattan Hospital, New York, New York, USA
  1. Correspondence to Dr Thinzar Lwin, t2lwin{at}ucsd.edu

Summary

Mixed corticomedullary adrenal tumours (MCMT) are rare. We describe the second reported case of a male patient presenting with hypertension and Cushing syndrome with MCMT. A man aged 48 years presented with hypertension and signs of Cushing syndrome. 24-hour urine cortisol was elevated, with detectable adrenocorticotropic hormone (ACTH). A high-dose dexamethasone suppression test indicated an adrenal or ectopic Cushing syndrome. Plasma metanephrines were normal. A 3 cm left adrenal mass was identified without potential ectopic sources of ACTH on imaging. After induction of anaesthesia for laparoscopic adrenalectomy, the patient developed resistant hypertension with stress-dose hydrocortisone administration. Surgery was cancelled and repeat testing revealed elevated plasma metanephrines. α-Blockade was administered for a presumed coexisting pheochromocytoma, and the patient underwent adrenalectomy. Pathology revealed an MCMT. This case highlights the importance of a thorough biochemical evaluation in patients with adrenal masses to rule out multiple hormone producing tumours.

https://doi.org/10.1136/bcr-2016-216965

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    Footnotes

    • Contributors JLM, TML, and NG reviewed the literature, analysed and interpreted the data and drafted revisions of the manuscript. SG analysed the slides of the tissue samples and contributed histological commentary. JLM was responsible for the conception of the case report, supervised data analysis and interpretation, and revised it critically. All authors approve of the final version of the submitted manuscript.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.