Cushings Syndrome With Bilateral Adrenal Masses: What Management?

Abstract

ACTH independent Cushings syndrome (CS) with bilateral adrenal masses is an extremely rare entity. Its management constitutes a challenge to clinicians due to difficulty of exact location of the functional lesions. We herein report a case of a 42-year-old patient with a heavy smoking history who presented a CS for 2 years. Serial examinations revealed ACTH independent CS and bilateral adrenal masses on adrenal computed tomography the largest was on the left measuring 30 x 27 mm. Then the patient underwent a laparoscopic adrenalectomy for left adrenal tumor which diagnosed as an adrenal cortical adenoma with a Weiss Score <2 by the pathological reports. The immediate post-operative course was marked by a corticotroph deficiency that was substituted. The removal of the largest adrenal lesion could represent a therapeutic alternative in the management of bilateral adrenal masses when functional and / or invasive exploration isnt available.