Main Article Content

Authors

The primary bilateral macronodular adrenal hyperplasia or the independent adrenocorticotropic hormone bilateral nodular adrenal hyperplasia is a rare cause hypercortisolism, its diagnosis is challenging and there is no clear way to decide the best therapeutic approach. Adrenal venous sampling is commonly used to distinguish the source of hormonal production in patients with primary hyperaldosteronism. It could be a useful tool in this context because it might provide information to guide the treatment. We report the case of a patient with ACTH independent Cushing syndrome in whom the use of adrenal venous sampling with some modifications radically modified the treatment and allowed the diagnosis of a macronodular adrenal hyperplasia.

Carlos Esteban Builes-Montaño, Hospital Pablo Tobón Uribe

Sección de Endocrinología, Departamento de Medicina Interna. Hospital Pablo Tobón Uribe

Carlos Andres Villa-Franco, Hospital Pablo Tobón Uribe

Departamento de Medicina Interna. Hospital Pablo Tobón Uribe

Alejandro Román-Gonzalez, Universidad de Antioquia

Sección de Endocrinología, Departamento de Medicina Interna. Universidad de Antioquia

Alejandro Vélez-Hoyos, Hospital Pablo Tobón Uribe

Departamento de Patología. Hospital Pablo Tobón Uribe

Santiago Echeverri-Isaza, Hospital Pablo Tobón Uribe

Departamento de Radiología. Hospital Pablo Tobón Uribe

Montoya-Escobar J, Builes-Montaño C, Johnayro G-R, Campuzano MG. Muestreo de senos petrosos inferiores en el diagnóstico de pacientes con síndrome de Cushing dependiente de hormona adrenocorticotrópica. Med Lab. 2013; 19(9-10): 411-50.

Dinneen SF, Carney JA, Carpenter PC, Grant CS, Young WF. Acth-independent Cushing’s syndrome: bilateral cortisol-producing adrenal adenomas. Endocr Pract. 1995; 1(2): 77-81. DOI: https://doi.org/10.4158/EP.1.2.77

Young WF Jr, du Plessis H, Thompson GB, Grant CS, Farley DR, Richards ML, et al. The clinical conundrum of corticotropin-independent autonomous cortisol secretion in patients with bilateral adrenal masses. World J Surg. 2008; 32(5): 856-62. DOI: https://doi.org/10.1007/s00268-007-9332-8

De Venanzi A, Alencar GA, Bourdeau I, Fragoso MC, Lacroix A. Primary bilateral macronodular adrenal hyperplasia. Curr Opin Endocrinol Diabetes Obes. 2014; 21(3): 177-84. DOI: https://doi.org/10.1097/MED.0000000000000061

Young WF, Stanson AW, Thompson GB, Grant CS, Farley DR, van Heerden JA. Role for adrenal venous sampling in primary aldosteronism. Surgery. 2004; 136(6): 1227-35. DOI: https://doi.org/10.1016/j.surg.2004.06.051

Stewart PM, Allolio B. Adrenal vein sampling for Primary Aldosteronism: time for a reality check. Clin Endocrinol (Oxf). 2010; 72(2): 146-8. DOI: https://doi.org/10.1111/j.1365-2265.2009.03714.x

Maghrabi A, Yaqub A, Denning KL, Benhamed N, Faiz S, Saleem T. Challenges in the diagnostic work-up and management of patients with subclinical Cushing’s syndrome and bilateral adrenal masses. Endocrine Practice. 2013; 19(3): 515-21. DOI: https://doi.org/10.4158/EP12277.RA

Lieberman SA, Eccleshall TR, Feldman D. ACTH-independent massive bilateral adrenal disease (AIMBAD): a subtype of Cushing’s syndrome with major diagnostic and therapeutic implications. European J Endocrinol. 1994; 131(1): 67-73 DOI: https://doi.org/10.1530/eje.0.1310067

Akehi Y, Kawate H, Murase K, Nagaishi R, Nomiyama T, Nomura M, et al. Proposed diagnostic criteria for subclinical Cushing’s syndrome associated with adrenal incidentaloma. Endocrine J. 2013;60(7):903-12. DOI: https://doi.org/10.1507/endocrj.EJ12-0458

Kidambi S, Raff H, Findling JW. Limitations of nocturnal salivary cortisol and urine free cortisol in the diagnosis of mild Cushing’s syndrome. European J Endocrinol. 2007; 157(6): 725-31. DOI: https://doi.org/10.1530/EJE-07-0424

Lacroix A. ACTH-independent macronodular adrenal hyperplasia. Best Prac Res Clin Endocrinol Metab. 2009; 23(2): 245-59. DOI: https://doi.org/10.1016/j.beem.2008.10.011

Builes-Montaño, C. E., Villa-Franco, C. A., Román-Gonzalez, A., Vélez-Hoyos, A., & Echeverri-Isaza, S. (2015). Adrenal venous sampling in a patient with adrenal Cushing syndrome. Colombia Medica, 46(2), 84–87. https://doi.org/10.25100/cm.v46i2.1938

Downloads

Download data is not yet available.