A Case of Preclinical Cushing's Syndrome Associated with Diurnal Rhythms of ACTH and Cortisol in Blood: Correlation with Histological Findings

Abstract

Abstract. We describe a case of adrenocortical adenoma with preclinical Cushing's syndrome demonstrating diurnal rhythms of ACTH and cortisol in blood. A 50-year-old man was admitted to the hospital for the evaluation of incidental right adrenal mass with hyperglycemia and hypertension. On admission, there were no signs of clinical manifestation of hypercortisolism. The basal levels of cortisol (9.3 µg/dl) and ACTH (9.4 pg/ml) at 0800 h were not elevated and these diurnal rhythms were maintained. One or 8 mg of dexamethasone given orally overnight suppressed the plasma ACTH but not serum cortisol. Ultrasonogram, CT and scintiscan of 131 I adosterol all demonstrated an enlarged adrenal mass in the right adrenal gland. The right adrenal gland was subsequently resected by laparoscopic surgery. Histopathological findings of resected adrenal tumor were consistent with adrenocortical adenoma. Adjacent non-neoplastic adrenal tissue demonstrated adrenocortical atrophy but DHEA-sulfotransferase immunoreactivity in the zona reticularis was detected. We report a case of preclinical Cushing's syndrome associated with diurnal rhythms of ACTH and cortisol in blood including histopathological findings and immunohistochemical evaluation of steroidogenic enzymes. Case Report and MethodsA 50-year-old man was admitted to our hospital for evaluation of incidental right adrenal tumor associated with hyperglycemia and hypertension. Hypertension had been pointed out since he was 30 years old. At 44 years of age, he received lithectomy for ureterolithiasis. At 45 years of age, hyperglycemia was detected by regular health check up. His mother had hypertension and diabetes mellitus. Prior to admission, hypertension (176/107 mmHg) and hyperglycemia with 191 mg/dl in fasting blood glucose and 9.2% in HbA1c were noted. In addition, a right adrenal mass was detected by an abdominal echogram, which was performed by regular health check up. His chief complaints at the time of admission were polydipsia, polyuria and thirst. He was 162 cm tall and weighed 62.5 kg, and had BMI of 23.4 kg/m 2 . His pulse was 68/min and regular, with blood pressure of 182/

Characteristics of aldosterone-producing adenomas in patients without plasma renin activity suppression

“…In addition, the difference between the unsuppressed and suppressed PRA groups was not significant for other factors, including the levels of ACTH, urinary cortisol, and cortisol measured via sAVS, as well as CYP11B1 expression. Moreover, not all patients with subclinical hypercortisolism exhibited elevated PRA levels [ 41 ]. Further investigation is needed to identify the possible relationship between unsuppressed PRA and higher cortisol secretion among patients with PA.…”

An ectopic ACTH-producing small cell lung carcinoma associated with enhanced corticosteroid biosynthesis in the peritumoral areas of adrenal metastasis

“…In this report, we firstly demonstrated abundant corticosteroid synthesis in the adrenals of EAS due to SCLC metastasis. The finding that corticosteroids may be synthesized more abundantly in the areas adjacent to the adrenal metastasis suggests that in situ high concentration of ACTH may be generated by paracrine actions of metastatic carcinoma cells on their surrounding tissue [12,14].…”

Untitled

“…This retrospective study protocol was approved by the Research Ethics Committee of Yokohama Rosai Hospital (approval no. [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46].…”