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Adrenal Incidentalomas with Supraphysiologic Response to ACTH Stimulus: A Case Report
Marianna Antonopoulou1, Asya Perelstein
1SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1205, Brooklyn, NY 11203, USA.
Case Reports in Endocrinology
|October 26, 2012
Summary
This case study details the diagnostic challenges of adrenal incidentalomas, revealing a rare presentation of subclinical Cushing's syndrome and extramedullary plasmacytoma. Further investigation is crucial for accurate diagnosis and management.
Area of Science:
- Endocrinology
- Oncology
Background:
- Adrenal incidentalomas are common, but their evaluation requires careful consideration of potential hormonal activity and malignancy.
- A 72-year-old male presented with bilateral adrenal masses discovered incidentally on CT scan.
Purpose of the Study:
- To outline the diagnostic pathway for complex adrenal incidentalomas with atypical hormonal profiles.
- To differentiate between subclinical Cushing's syndrome and rare adrenal neoplasms.
Main Methods:
- Computed tomography (CT) scan for adrenal mass characterization.
- Hormonal workup including ACTH stimulation test.
- Dexamethasone suppression test for Cushing's syndrome screening.
- Review of differential diagnoses including congenital adrenal hyperplasia, Cushing's syndrome, and extramedullary plasmacytoma.
Main Results:
- Initial hormonal workup was negative. ACTH stimulation suggested congenital adrenal hyperplasia (CAH) but with atypical cortisol response.
- Dexamethasone suppression test indicated subclinical Cushing's syndrome (SCS), likely due to ACTH-independent macronodular adrenal hyperplasia.
- The patient's history of MGUS raised suspicion for extramedullary plasmacytoma, a rare adrenal malignancy.
Conclusions:
- The diagnostic approach for adrenal incidentalomas can be complex, especially with overlapping hormonal abnormalities.
- Subclinical Cushing's syndrome and extramedullary plasmacytoma represent critical differential diagnoses in this case.
- Multidisciplinary evaluation is essential for managing patients with adrenal incidentalomas and complex clinical presentations.
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