A RARE CASE OF CUSHINGS-SYNDROME DUE TO BILATERAL ADRENOCORTICAL ADENOMAS

We report a rare case of Gushing's syndrome due to bilateral adrenocor tical adenomas in a 45-year-old female. She suffered from diabetes mel litus and hypertension for a decade, but her appearance was not Cushin goid. The plasma cortisol level in the morning was at the upper limit of the normal range, but did not show a diurnal rhythm or was suppress ed by I mg of dexamethasone. The plasma level of ACTH was undetectable , and it failed to respond to human CRH (hCRH). Plasma cortisol respon ded well to synthetic ACTH. The urinary 17-OHCS level was high, and wa s not suppressed by 4 mg of dexamethasone. While these findings were c onsistent with a diagnosis of adrenocortical adenoma, computed tomogra phy showed several nodules in both adrenal glands that suggested the p resence of huge nodular adrenocortical hyperplasia or bilateral adreno cortical adenomas. Bilateral adrenalectomy demonstrated the presence o f three adenomas, two in the right and one in the left adrenal. Analys is of the extract from each adenoma revealed that two of the three pro duced an excess amount of cortisol. Magnetic resonance imaging (MRI) o f the brain suggested the presence of a pituitary adenoma. Prior to ad renalectomy, TSH, GH or LH showed a low response to TRH, GHRH or LHRH, respectively. Since normal responses were restored after bilateral ad renalectomy, these abnormalities were attributed to hypercortisolemia.