Adrenal Cushing syndrome with detectable ACTH from an unexpected source

Thinzar M. Lwin, Nehal Galal, Shweta Gera, Jennifer L. Marti

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Article number216965
JournalBMJ Case Reports
Volume2016
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

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Cushing Syndrome
Adrenocorticotropic Hormone
Glandular and Epithelial Neoplasms
Metanephrine
Adrenalectomy
Hypertension
Hydrocortisone
Pheochromocytoma
Dexamethasone
Anesthesia
Urine
Hormones
Pathology
Neoplasms

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Adrenal Cushing syndrome with detectable ACTH from an unexpected source. / Lwin, Thinzar M.; Galal, Nehal; Gera, Shweta; Marti, Jennifer L.

In: BMJ Case Reports, Vol. 2016, 216965, 01.01.2016.

Research output: Contribution to journalArticle

Lwin, Thinzar M. ; Galal, Nehal ; Gera, Shweta ; Marti, Jennifer L. / Adrenal Cushing syndrome with detectable ACTH from an unexpected source. In: BMJ Case Reports. 2016 ; Vol. 2016.
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