Adrenal incidentalomas: a simple guide to a disease of modern technology

S Ghosh, M Jones, K Swaminathan
2010 The Journal of the Royal College of Physicians of Edinburgh  
A 33-year-old woman was found to have an incidental adrenal mass during ultrasound imaging for recurrent urinary tract infections. This was subsequently confirmed by computed tomography (CT), which showed a wellcircumscribed 3 x 3.7 cm lesion with a density of 40 Hounsfield units (HU) (Figure 1 ). She was clinically Cushingoid with a history of hypertension, impaired glucose tolerance, hirsutism and amenorrhoea. Adrenocorticotrophic hormone (ACTH) independent Cushing's syndrome was confirmed
more » ... ed on the elevated urine 24-hour cortisol/creatinine ratio (269 nmol/mmol, normal range 0-25), undetectable levels of serum ACTH (<1 milliunits/litre, normal range 2-20) and lack of cortisol suppression with dexamethasone administration (serum cortisol of 561 nmol/l after two days of 0.5 mg dexamethasone). She had a laparoscopic adrenalectomy with good effect. Case 2 Correspondence to K Swaminathan, Victoria Hospital, Kirkcaldy KY2 5AH, UK tel. +44 (0)1592 643355 ext. 1582 e-mail J R Coll Physicians Edinb 2010; 40:314-6
doi:10.4997/jrcpe.2010.407 pmid:21132138 fatcat:aqn5z5edmjbefn4dasxnuhclhe