AUTONOMOUS NODULAR HYPERPLASIA OF THE ADRENAL-CORTEX - TERTIARY HYPERCORTISOLISM

Two cases of Gushing's syndrome are reported in which apparently auton omous adrenal adenomata were associated with the presence of pituitary tumours. In one case the patient was apparently cured by unilateral a drenalectomy, although she was noted to have radiological evidence of an intrasellar tumour; serum cortisol was not suppressed by dexamethas one and ACTH was undetectable. Serum ACTH in the second case was initi ally 31 ng/l but became undetectable during the course of investigatio n. Transsphenoidal removal of a corticotroph adenoma did not affect se rum cortisol and she proceeded to unilateral adrenalectomy. The pathog enesis of autonomous macronodular hyperplasia is discussed, as well as the options for management.