Incidentally discovered ACTH-dependent adrenal adenoma presenting as 'Pre-Cushing's syndrome'
- 1 January 1986
- journal article
- research article
- Published by Oxford University Press (OUP) in Acta Endocrinologica
- Vol. 111 (1) , 89-92
- https://doi.org/10.1530/acta.0.1110089
Abstract
An adrenal tumor was incidentally discovered with no clinical signs of Cushing''s syndrome. The endocrine evaluation revealed the unique hormonal constellation of an increased urinary cortisol excretion rate, unequivocal suppressibility of plasma and urinary cortisol by dexamethasone, but only to a residual level in the low normal range which probably reflected ACTH-independent ''autonomous'' cortisol secretion. After removal of the adrenal mass, urinary cortisol secretion and dexamethasone suppressibility were normalized. In vitro, the tumor cells were as sensitive towards ACTH as ''normal'' human adrenal cells, but showed a reduced cortisol production rate per cell. We suppose that the adrenal mass participated in the diurnal rhythm of ACTH-mediated cortisol secretion in vivo, which resulted in an increased cortisol secretion. During the night, when ACTH levels were low, the cortisol production decreased and the hormone levels were probably too low to suppress ACTH. We regard the hormonal findings in our patients as ''Pre-Cushing''s syndrome'', although the absence of clinical features of Cushing''s syndrome remains unclear. We suggest that every patient with an incidentally discovered adrenal mass should have an endocrinological evaluation because the results may help to decide whether or not the adrenal tumor should be removed.This publication has 3 references indexed in Scilit:
- Effects of angiotensin II and ACTH on normal and tumourous human adrenocortical cellsActa Endocrinologica, 1983
- The Incidentally Discovered Adrenal MassAnnals of Internal Medicine, 1983
- Incidental asymptomatic adrenal masses detected by computed tomographic scanning. Is operation required?JAMA, 1982