A patient with a high titer of antinuclear antibody and a functioning adrenal tumour

Reported is the case of a 60-year-old female who was referred to our rheumatology center because of a high titer of antinuclear antibodies (ANAs). Initially several lupus-like features suggested a diagnosis of undifferentiated connective tissue disease (UCTD). Immunofluorescence of the patient's serum showed a nuclear dot pattern. Counterimmunoelectrophoresis for antibodies to Sm, RNP, SS-A and SS-B were negative. Immunoblotting revealed a band at 53 kD which did not correspond to known autoantigens. Several months later the patient presented to the emergency room with symptoms due to a hypertensive crisis. Check-up finally revealed a cortisone-producing tumour of the right adrenal gland. The adenoma was removed by surgery and the patient did well again.