Case Report: A case study on bilateral macronodular adrenocortical disease: ACTH-independent hypercortisolism with refractory diabetes and hypertension
Year: 2026
Type: article
Study design: Case Report
Abstract: Background Bilateral macronodular adrenocortical disease is a rare cause of ACTH-independent hypercortisolism. Some patients present without typical Cushingoid features, which may lead to delayed diagnosis. Case Presentation A 53-year-old woman presented with poorly controlled diabetes and resistant hypertension despite three antihypertensive agents. She lacked typical Cushingoid features. Laboratory evaluation showed elevated 24-hour urinary free cortisol (UFC) (1656.00 μg/24h; normal: 75.00–520.00 μg/24h), absent circadian rhythm, suppressed ACTH (<5 pg/mL), and non-suppression on low-dose dexamethasone suppression test. Contrast-enhanced CT revealed bilateral adrenal multiple nodular lesions (left: 46×35 mm; right: 57×42 mm). A diagnosis of BMAD with ACTH-independent hypercortisolism without classic Cushingoid features was established. Management and Outcome The patient underwent right unilateral adrenalectomy. Postoperatively, glycemic control and blood pressure improved rapidly. At two-year follow-up, cortisol levels remained normal, and both antihypertensive and antidiabetic medications were discontinued without relapse. Conclusion BMAD can present with isolated metabolic comorbidities without classic CS features. In selected patients with asymmetric BMAD and ACTH-independent hypercortisolism without classic Cushingoid features, unilateral adrenalectomy of the larger gland may represent a reasonable adrenal-sparing option, achieving sustained biochemical and metabolic remission even in the presence of markedly elevated preoperative UFC levels.
Source: Frontiers in Endocrinology
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7222916245