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Adrenocarticotropic hormone‐independent bilateral macronodular adrenocortical hyperplasia associated with Cushing's syndrome
Author(s) -
Irie Junji,
Kawai Kioko,
Shigematsu Kazuto,
Suzuki Shin,
Nomata Koichiro,
Minami Yuzo,
Kanetake Hiroshi
Publication year - 1995
Publication title -
pathology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 74
eISSN - 1440-1827
pISSN - 1320-5463
DOI - 10.1111/j.1440-1827.1995.tb03448.x
Subject(s) - medicine , adrenocorticotropic hormone , adrenal cortex , cushing syndrome , hyperplasia , pathology , zona glomerulosa , dexamethasone , adrenocortical adenoma , zona reticularis , endocrinology , adenoma , hormone , angiotensin ii , blood pressure
A case of adrenocorticotropic hormone independent bilateral adrenocortical macronodular hyperplasia (AIMAH) is reported. A 59 year old male was admitted to hospital because of hypertension. Subsequently, hypercortisolism, low plasma adrenocorticotropic hormone (ACTH), loss of diurnal rhythm of ACTH, lack of suppression with high dose dexa‐methasone were found and bilateral adrenal enlargement was detected by abdominal computerized tomography and adrenal scintlgraphy. Bilateral total adrenalectomy was performed under a diagnosis of bilateral adrenal hyperplasia associated with Cushing's syndrome. Both adrenal glands were enlarged in size and weight. Bulging nodules were found at the cut section. Microscopically, a variegated histologic pattern including trabecular, adenoid and zona glomerulosa‐like (ZG‐like) structures was revealed in the nodules. lmnunohistochemical examination disclosed positive staining of cytochrome P‐450 1701, negative of 3p‐HSD in the ZG‐like structure. Ultrastructurally, the cells composing the ZG‐like structure were similar to those of the ZG in normal adrenal cortex. The authors agree that AIMAH is one of the entiiies causing Cushing's syndrome, and advise patholo‐gists to keep this disorder in mind when they examine the adrenals in Cushing's syndrome.