Remission of Cushing Syndrome in a Patient With Primary Pigmented Nodular Adrenocortical Disease With Unilateral Adrenalectomy

A Case Study

Abstract

In October 2001, a 45-year-old man presented to our clinic with a cushingoid appearance. Endocrine studies revealed adrenal-dependent Cushing syndrome. An adrenal scintigram with ¹³¹I-6β-iodomethyl-19-norcholesterol showed uptake of the isotope in the left adrenal gland on the second day and in the right adrenal gland on the fourth day after injection of the tracer. Computed tomography (CT) of the abdomen displayed a nodule (2 cm in diameter) on the left adrenal gland and a normal-appearing right adrenal gland. A laparoscopic left adrenalectomy was performed in November 2001. Primary pigmented nodular adrenocortical disease (PPNAD) was diagnosed pathologically.

Cushingoid features persisted after the surgery. A repeat computed tomography of the abdomen demonstrated a residual nodule (1.5 cm in diameter) on the left adrenal gland. The patient then underwent an open left total adrenalectomy in March 2002. Following this procedure, the patient's cushingoid appearance progressively resolved. Cushing syndrome remains in remission some 69 months after unilateral total adrenalectomy.