PRIMARY PIGMENTED NODULAR ADRENOCORTICAL DYSPLASIA

A 29-year-old female patient presented clinical features of Gushing's syndrome. Biochemical tests suggested the presence of an autonomously functioning adrenocortical neoplasm. However, the adrenal glands were normal on MRI. Diagnostic adrenalectomy revealed a slightly enlarged o rgan studded externally and on multiple cut surfaces by small yellow a nd brown nodules. Microscopically, the nodules were composed of enlarg ed cortical cells with eosinophilic cytoplasm and nuclear pleomorphism , without mitotic figures. The morphology was consistent with primary pigmented nodular adrenocortical dysplasia (PPNAD). Additional right a drenalectomy was performed for curative treatment of Gushing's syndrom e. The pathogenesis of PPNAD is not yet established, though, a defect on chromosome 16 was recently suggested. Since our patient had a malig nant melanoma earlier in her history, the PPNAD may be a manifestation of the Carney complex.