Adrenal Incidentalomas with Supraphysiologic Response to ACTH Stimulus: A Case Report
We present the diagnostic approach of a patient with adrenal incidentalomas. A 72-year-old African American male had a CT scan of the abdomen showing right and left adrenal masses measuring and , respectively. The patient had negative hormonal workup. The radiologist insisted that the CT findings a...
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| Format: | Article |
| Language: | English |
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Wiley
2012-01-01
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| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2012/503290 |
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| author | Marianna Antonopoulou Asya Perelstein |
| author_facet | Marianna Antonopoulou Asya Perelstein |
| author_sort | Marianna Antonopoulou |
| collection | DOAJ |
| description | We present the diagnostic approach of a patient with adrenal incidentalomas. A 72-year-old African American male had a CT scan of the abdomen showing right and left adrenal masses measuring and , respectively. The patient had negative hormonal workup. The radiologist insisted that the CT findings are consistent with adrenal hyperplasia, and therefore he underwent ACTH stimulation to rule out late-onset congenital adrenal hyperplasia (CAH). The stimulation test revealed that 17-hydroxyprogesterone and 11-deoxycortisol increased to levels high enough to confirm CAH, but cortisol had exaggerated response as well, thus making the diagnosis of CAH unlikely where metabolism is shifted to precursors. Subsequently, the patient underwent screening for Cushing's syndrome (CS) with a dexamethasone suppression test. Patient failed the suppresion test, raising the issue for subclinical CS (SCS), likely due to ACTH-independent macronodular adrenal hyperplasia. Our patient had been diagnosed with MGUS and so far there are only 3 case reports of extramedullary plasmacytoma arising from the adrenals. One was bilateral and one had functional abnormalities. Our differential diagnosis includes subclinical CS with aberrant receptors versus a functioning extramedullary plasmacytoma. |
| format | Article |
| id | doaj-art-d74de06ac28b400f8c92011341ca8241 |
| institution | Kabale University |
| issn | 2090-6501 2090-651X |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-d74de06ac28b400f8c92011341ca82412025-02-03T00:59:34ZengWileyCase Reports in Endocrinology2090-65012090-651X2012-01-01201210.1155/2012/503290503290Adrenal Incidentalomas with Supraphysiologic Response to ACTH Stimulus: A Case ReportMarianna Antonopoulou0Asya Perelstein1SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1205, Brooklyn, NY 11203, USAVA Medical Center, 800 Poly Place, New York, NY 11209, USAWe present the diagnostic approach of a patient with adrenal incidentalomas. A 72-year-old African American male had a CT scan of the abdomen showing right and left adrenal masses measuring and , respectively. The patient had negative hormonal workup. The radiologist insisted that the CT findings are consistent with adrenal hyperplasia, and therefore he underwent ACTH stimulation to rule out late-onset congenital adrenal hyperplasia (CAH). The stimulation test revealed that 17-hydroxyprogesterone and 11-deoxycortisol increased to levels high enough to confirm CAH, but cortisol had exaggerated response as well, thus making the diagnosis of CAH unlikely where metabolism is shifted to precursors. Subsequently, the patient underwent screening for Cushing's syndrome (CS) with a dexamethasone suppression test. Patient failed the suppresion test, raising the issue for subclinical CS (SCS), likely due to ACTH-independent macronodular adrenal hyperplasia. Our patient had been diagnosed with MGUS and so far there are only 3 case reports of extramedullary plasmacytoma arising from the adrenals. One was bilateral and one had functional abnormalities. Our differential diagnosis includes subclinical CS with aberrant receptors versus a functioning extramedullary plasmacytoma.http://dx.doi.org/10.1155/2012/503290 |
| spellingShingle | Marianna Antonopoulou Asya Perelstein Adrenal Incidentalomas with Supraphysiologic Response to ACTH Stimulus: A Case Report Case Reports in Endocrinology |
| title | Adrenal Incidentalomas with Supraphysiologic Response to ACTH Stimulus: A Case Report |
| title_full | Adrenal Incidentalomas with Supraphysiologic Response to ACTH Stimulus: A Case Report |
| title_fullStr | Adrenal Incidentalomas with Supraphysiologic Response to ACTH Stimulus: A Case Report |
| title_full_unstemmed | Adrenal Incidentalomas with Supraphysiologic Response to ACTH Stimulus: A Case Report |
| title_short | Adrenal Incidentalomas with Supraphysiologic Response to ACTH Stimulus: A Case Report |
| title_sort | adrenal incidentalomas with supraphysiologic response to acth stimulus a case report |
| url | http://dx.doi.org/10.1155/2012/503290 |
| work_keys_str_mv | AT mariannaantonopoulou adrenalincidentalomaswithsupraphysiologicresponsetoacthstimulusacasereport AT asyaperelstein adrenalincidentalomaswithsupraphysiologicresponsetoacthstimulusacasereport |