COEXISTENCE OF UNILATERAL ADRENAL MACRONODULE AND CUSHINGS-DISEASE - REPORT OF 2 CASES

The coexistence of an unilateral adrenal macronodule and Cushing's dis ease is well documented in only few reports, We hereby describe two pa tients with ACTH-dependent Cushing's syndrome and asymmetric adrenal i nvolvement, In both patients the left-sided adrenal contained a nodule sized 1.5 and 1.4 cm, respectively, while the contralateral gland app eared as normal at abdominal computerized tomography. Adrenal scintisc an revealed a bilateral uptake of the tracer, Dynamic testing of hypot halamic-pituitary-adrenal axis was suggestive of pituitary dependency but neuroradiologic imaging was inconclusive. Inferior petrosal sinus sampling demonstrated a clear center to periphery ACTH gradient and an ACTH-producing pituitary microadenoma was found and removed in both c ases. Hypopituitarism ensued postoperatively and Cushing's syndrome re solved but the adrenal nodules regressed only many month after operati on, The present cases confirm that the presence of an adrenal mass in a patient with Cushing's syndrome is insufficient to confidently concl ude for the adrenal dependency of the syndrome.