A 64-year-old woman was referred to our unit for an incidentally discovered right adrenal mass. She had no clinical features of Cushing's syndrome. She had normal serum cortisol and ACTH, but the cortisol diurnal rhythm was absent, and plasma cortisol was not suppressed by loperamide test or by overnight low (1 mg) and high (8 mg) dose dexamethasone. 131I-Norcholesterol scintigraphy showed abnormal uptake of the radiotracer in the region of the right adrenal gland. After right adrenalectomy, adrenal insufficiency developed that required cortisol replacement for 10 months. At the end of this period, there was full recovery of the hypothalamic-pituitary adrenal axis, and scintigraphy revealed normal uptake of the previously suppressed left adrenal gland. We conclude that 'pre-Cushing's syndrome' is a real clinical entity, and preoperative diagnosis will alert the clinician to the possibility of unanticipated adrenal crisis if the mass is removed.
A Documented Clinical Case of Pre-Cushing's Syndrome
BERNINI, GIAMPAOLO;
1995-01-01
Abstract
A 64-year-old woman was referred to our unit for an incidentally discovered right adrenal mass. She had no clinical features of Cushing's syndrome. She had normal serum cortisol and ACTH, but the cortisol diurnal rhythm was absent, and plasma cortisol was not suppressed by loperamide test or by overnight low (1 mg) and high (8 mg) dose dexamethasone. 131I-Norcholesterol scintigraphy showed abnormal uptake of the radiotracer in the region of the right adrenal gland. After right adrenalectomy, adrenal insufficiency developed that required cortisol replacement for 10 months. At the end of this period, there was full recovery of the hypothalamic-pituitary adrenal axis, and scintigraphy revealed normal uptake of the previously suppressed left adrenal gland. We conclude that 'pre-Cushing's syndrome' is a real clinical entity, and preoperative diagnosis will alert the clinician to the possibility of unanticipated adrenal crisis if the mass is removed.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
