Guess the case from the ochsner clinic.
Year: 2007
Type: article
Study design: Case Report
Abstract: A 63-year-old man complaining of painless hematuria was seen by his primary care physician. Prostatitis was diagnosed by history and urinalysis. A computed tomographic (CT) scan revealed a left adrenal mass measuring 3.8 cm in diameter (see Figure 1). No evidence of nephrolithiasis was seen, and he was referred to the Endocrinology Department for evaluation of the adrenal mass.
Figure 1
Non-contrast CT demonstrating left adrenal mass.
His medical history is significant for hypertension, coronary artery disease requiring stenting, carotid artery stenosis requiring angioplasty, and dyslipidemia. His surgical history includes a neck exploration after trauma, tonsillectomy, adenoidectomy, hemorrhoidectomy, and cataract surgery. He is a smoker and drinks alcohol occasionally. His father had a brain tumor and his mother had dementia, heart disease, and diabetes. He denied any family history of pituitary or adrenal disorders.
His medications include clopidogrel, aspirin, simvastatin, atenolol, and valsartan. He denied vision changes, headaches, chest or abdominal pain, diaphoresis, polyuria, nocturia, paresthesias, or erectile dysfunction. He had no history of depression or fractures.
His blood pressure was 165/80 mm Hg with a pulse of 70 beats per minute. Physical examination revealed an obese (229 lb, 71 in, body mass index = 30) man. There were no abdominal striae, moon facies, or supraclavicular fullness, and no skin abnormalities or bruising. The remainder of his physical examination was unremarkable.
Upon review of his past laboratory studies, fasting hyperglycemia (118–165 mg/dL) was noted. A biochemical work-up (Table 1) was significant for abnormal 1 mg dexamethasone suppression, elevated urinary cortisol, and low adrenocorticotropic hormone (ACTH). A repeat 24-hr urine cortisol level remained elevated at 87 µg/24 h. Bone mineral density was normal.
Table 1
Initial biochemical data.
What Is The Diagnosis?
Subclinical Cushing's syndrome (SCCS) was diagnosed because of the presence of an adrenal mass with abnormal 24-hr urinary-free cortisol, abnormal dexamethasone suppression, and comorbid hypertension, hyperglycemia, obesity, and cerebrovascular and coronary artery disease. A surgical consultation was obtained.
The patient underwent a laparoscopic left adrenalectomy using an anterolateral transabdominal approach without complication. Perioperative steroids were not administered. His postoperative course was unremarkable, and he was discharged to home on postoperative day 1. Pathological analysis showed a 6-cm benign cortical adenoma.
Postoperative laboratory studies showed normal 1 mg overnight dexamethasone suppression (1.2 µg/dL), resolution of his urinary hypercortisolism (43 µg/24 h) as well as normalization of his ACTH level (16 pg/mL). At 3-month follow-up, he has lost 5 pounds and has normal fasting blood glucose levels. His blood pressure has decreased to 130/65 mm Hg without medication changes.
Source: PubMed
Institution: Ochsner Medical Center
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1842453522