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A Rare Case of Adrenocorticotropic Hormone (ACTH)-Secreting Pheochromocytoma Presenting With Severe Cushing Syndrome (CS) and Dual Hormonal Secretion

Year: 2025

Type: article

Abstract: We present a rare case of a 58-year-old woman diagnosed with an adrenocorticotropic hormone (ACTH)-secreting pheochromocytoma, manifesting as severe Cushing syndrome (CS) with dual-hormonal secretion. She had a three-week history of upper-body tremors, hyperglycemia, hypokalemia, and new-onset, treatment-resistant hypertension. Biochemical investigations revealed markedly elevated cortisol, ACTH, and catecholamine levels. Imaging identified a 3.4 cm enhancing left adrenal mass, and further functional imaging and hormonal assays confirmed the diagnosis. She underwent laparoscopic adrenalectomy following medical stabilization with alpha-blockade and metyrapone. Histopathology confirmed a low-risk pheochromocytoma with positive ACTH immunostaining. Postoperatively, the patient had complete resolution of hypercortisolism, normalization of metabolic parameters, and significant clinical improvement. This case highlights the importance of recognizing dual-hormonal secretion in adrenal tumors, as early detection allows safer preoperative optimization and reduces perioperative risk. It also emphasizes maintaining a high index of suspicion for ectopic ACTH production in rapidly progressing CS. Early diagnosis and appropriate preoperative management are critical to reducing morbidity and mortality.

Source: Cureus

DOI: 10.7759/cureus.97772

Authors: Yi Yi Aung, Nicholas Hutton, Sawsan Hamdan, Robert Hadden, Tarig Babiker

Institution: University Hospitals Plymouth NHS Trust

Language: English

Topic: Adrenal and Paraganglionic Tumors

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4416664019