Randall Colucci, Rafael E. Jimenez, William Farrar, Ramiro Malgor, Leonard Kohn, Frank L. Schwartz. Coexistence of Cushing Syndrome From Functional Adrenal Adenoma and Addison Disease From Immune-Mediated Adrenalitis. J Am Osteopath Assoc 2012;112(6):374–379. doi: 10.7556/jaoa.2012.112.6.374.
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A 56-year-old woman presented with an incidental adrenal adenoma and physical examination findings that included moderate obesity, a slight cervicothoracic fat pad (“buffalo hump”), increased supraclavicular fat pads, and white abdominal striae. Biochemical workup revealed elevated levels of 24-hour urinary free cortisol but normal serum morning cortisol and suppressed levels of corticotropin, suggestive of adrenal-dependent Cushing syndrome. The resected adrenal gland revealed macronodular cortical hyperplasia with a dominant nodule. Other findings included an absent cortisol response to corticotropin stimulation, presence of serum anti-21-hydroxylase antibodies, and mononuclear cell infiltration—consistent with adrenalitis. The findings represent, to the authors' knowledge, the first known case of a patient with coexistent functional cortisol-secreting macronodular adrenal tumor resulting in Cushing syndrome and immune-mediated adrenalitis resulting in Addison disease.
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