Utilization of bilateral percutaneous microwave ablation of the adrenal glands in ectopic Cushing's syndrome

Ectopic Cushing's syndrome (CS) is rare and difficult to cure when the source is elusive. Medical management is complex and often times contraindicated in the medically complex patient. We present a complicated case of ectopic CS where bilateral percutaneous microwave ablation (MWA) of the adrenal glands successfully cured hypercortisolism when surgery and medical therapies were contraindicated. A 71-year-old male was diagnosed with ectopic CS after adrenocorticotropic hormone-dependent hypercortisolism persisted after hypophysectomy despite a positive gradient of >3 on inferior petrosal sinus sampling. An ectopic source was not identified. Surgery and medical therapies were contraindicated due to comorbidities and drug interactions. Bilateral MWA of the adrenal glands was performed. Postprocedurally cortisol levels declined and the patient was clinically adrenally insufficient at 6 months. Bilateral MWA of the adrenal glands can prove to be an effective treatment option for ectopic CS when surgical resection and medical therapies are ineffective or contraindicated.