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Cushing Syndrome I: Introduction01:26

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Cushing syndrome refers to the collection of clinical manifestations that arise when tissues are exposed to excessive amounts of cortisol or cortisol-like medications over an extended period. Cortisol, a glucocorticoid produced by the adrenal cortex, regulates metabolism, immune responses, and the body’s adaptation to stress. When its concentration remains chronically elevated, these physiological pathways become dysregulated, resulting in the characteristic features of the...
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Cushing Syndrome II: Pathophysiology01:19

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Bilateral macronodular adrenocortical disease: a single centre experience.

Anuj Ban, Rohit Barnabas, Manjiri Karlekar

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    Bilateral macronodular adrenocortical disease (BMAD) often presents incidentally without hormonal excess. Detailed CT scan characteristics of adrenal nodules aid in diagnosing BMAD, with most patients showing stable health on follow-up.

    Keywords:
    AIMAHBMADCT scanCushing’s syndromePBMAHadrenal Cushing’s

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    Area of Science:

    • Endocrinology
    • Radiology
    • Genetics

    Background:

    • Bilateral macronodular adrenocortical disease (BMAD) is characterized by bilateral adrenal nodules larger than 1 cm.
    • Limited data exist on computed tomography (CT) characteristics and long-term outcomes for BMAD.

    Purpose of the Study:

    • To describe the clinical, biochemical, radiological, and genetic features of BMAD patients.
    • To evaluate management strategies and long-term follow-up outcomes in a single center.

    Main Methods:

    • Retrospective study of 22 BMAD patients.
    • Analysis of CT scan findings (attenuation, washout, size), hormonal secretion, genetic data, and clinical outcomes.
    • Definition of BMAD based on bilateral adrenal macronodules (>1 cm) on CT.

    Main Results:

    • Most patients (82%) were incidentally diagnosed, with 11 having mild autonomous cortisol secretion (MACS) and 7 being non-secretory.
    • Nodules were predominantly lipid-rich (77.8%) with good washout (93.3%).
    • One patient developed diabetes mellitus during follow-up; no new comorbidities were observed in non-secretory patients.

    Conclusions:

    • BMAD frequently presents without overt hormonal excess, and overt Cushing's syndrome did not develop during follow-up.
    • CT characteristics of adrenal nodules are valuable for diagnosing bilateral adrenal incidentalomas.
    • Long-term follow-up suggests a generally stable clinical course for non-secretory BMAD.