ADRENOCORTICOTROPIC HORMONE-INDEPENDENT BILATERAL MACRONODULAR ADRENOCORTICAL HYPERPLASIA ASSOCIATED WITH CUSHINGS-SYNDROME

A case of adrenocorticotropic hormone independent bilateral adrenocort ical macronodular hyperplasia (AIMAH) is reported, A 59 year old male was admitted to hospital because of hypertension, Subsequently, hyperc ortisolism, low plasma adrenocorticotropic hormone (ACTH), loss of diu rnal rhythm of ACTH, lack of suppression with high dose dexamethasone were found and bilateral adrenal enlargement was detected by abdominal computerized tomography and adrenal scintigraphy. Bilateral total adr enalectomy was performed under a diagnosis of bilateral adrenal hyperp lasia associated with Gushing's syndrome, Both adrenal glands were enl arged in size and weight, Bulging nodules were found at the cut sectio n. Microscopically, a variegated histologic pattern including trabecul ar, adenoid and zona glomerulosa-like (ZG-like) structures was reveale d in the nodules, Immunohistochemical examination disclosed positive s taining of cytochrome P-450 17 alpha, negative of 3 beta-HSD in the ZG -like structure, Ultrastructurally, the cells composing the ZG-like st ructure were similar to those of the ZG in normal adrenal cortex, The authors agree that AIMAH is one of the entities causing Gushing's synd rome, and advise pathologists to keep this disorder in mind when they examine the adrenals in Gushing's syndrome.