Cushing's Syndrome with Accessory Adrenocortical Tissue

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Abstract
FUNCTIONAL SIGNIFICANCE of accessory adrenocortical tissue has been considered unlikely by most authorities. Soffer et al1state that "it is a question as yet unanswered... as to whether these accessory bodies could be sufficiently functional under suitable circumstances." Graham2mentions a patient who after receiving large amounts of corticotropin (ACTH) showed marked thickening and vacuolation of the cortical tissue in both the normal adrenals and an accessory adrenal gland at autopsy. He states that this suggests the ability of such accessory cortical tissue to respond to the stimulus of corticotropin. We have had the opportunity to study a patient who showed continued classical Cushing's syndrome after bilateral total adrenalectomy. A large accessory adrenal gland was then discovered and removed with resultant clinical improvement and frank adrenal insufficiency. He died 18 months later from a superior mediastinal malignancy. This case is of unusual interest since the authors know of

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