Functioning adrenal black adenoma with pulmonary and cutaneous cryptococcosis: A case report and review of English literature

A 53-year-old woman experienced progressive general weakness and lumbago in the 2 years prior to a physical examination which disclosed cushingoid man ifestations and a skin ulcer on the back of her right knee joint. Her plasm a cortisol concentration ranged from 24.7 to 31.1 mug/dl, with an ACTH leve l <5 pg/ml. Urinary excretions of 17-hydroxycorticosteroid (17-OHCS) and 17 -ketosteroid (17-KS) were 20.5 mg/day and 5.1 mg/day, respectively, and uri nary cortisol was also increased (421 mug/day). Cortisol was not suppressed after the administration of 8 mg dexamethasone. Abdominal ultrasound sonog raphy, computed tomography (CT) scan, and magnetic resonance imaging (MRI) studies demonstrated a left adrenal tumor and further, a chest X-ray examin ation showed a cavitary lesion containing a fungus ball-like mass in the le ft lower lung field. The serum cryptococcal antigen titer was positive at 1 :128 and a bronchoalveolar lavage fluid culture yielded a growth of Cryptoc occus neoformans. A biopsy specimen of the skin ulcer also suggested crypto coccosis. As a result, a left adrenectomy was performed, and the excised sp ecimen was shown to be an adenoma consisting of compact cells with abundant pigmentation (black adenoma). A diagnosis of functioning black adenoma of the adrenal gland, complicated with pulmonary and cutaneous cryptococcosis was made. (C) 2001, Editrice Kurtis.