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BMJ Case Reports 2017; doi:10.1136/bcr-2017-221674
  • Unusual presentation of more common disease/injury
  • CASE REPORT

Adrenal myelolipoma(s) as presenting manifestation of subclinical Cushing’s disease (eutopic ACTH-dependent Cushing’s syndrome)

  1. Rana Bhattacharjee2
  1. 1Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
  2. 2Department of Endocrinology and Metabolism, IPGME&R/SSKM Hospital, Kolkata, West Bengal, India
  1. Correspondence to Dr Partha Pratim Chakraborty, docparthapc{at}yahoo.co.in
  • Accepted 5 August 2017
  • Published 16 August 2017

Summary

Primary adrenal myelolipomas, relatively rare benign tumours of the adrenal cortex are typically unilateral, hormonally inactive and asymptomatic, hence often diagnosed as ‘adrenal incidentaloma’. Bilateral adrenal myelolipomas, in particular, may be associated with underlying endocrinopathies associated with elevated circulating adrenocorticotropic hormone (ACTH) concentration. Subclinical cortisol hypersecretion, irrespective of its ACTH dependency, does not manifest typical clinical phenotype of hypercortisolemia, and thus termed subclinical Cushing’s syndrome. In this article, hormonal evaluation in a middle-aged woman with diabetes, hypertension and incidentally discovered unilateral adrenal myelolipoma revealed underlying subclinical Cushing’s disease. Abdominal CT revealed another tiny focus in the contralateral adrenal gland, probably representing incipient myelolipoma.

Footnotes

  • Contributors PPC, SP and SNB were involved in diagnosis, management of the patient, literature search and writing the manuscript. RB contributed in work-up of the patient and provided intellectual inputs.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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