Anesthesia & Clinical Research
Open Access

Abstract

A Long-Standing Subtle Cushing's Syndrome Induced by a Unilateral Macronodular Adrenal Hyperplasia

Denegri A, Artom N, Moretti S, Bianchi F, Ottonello L, Pende A and Dallegri F

Cushing’s syndrome is a clinical picture characterized by signs and symptoms associated with a prolonged
exposure to inappropriately high level of the hormone cortisol. Described for the first time by Harvey Cushing in
1932, iatrogenic cause, by taking drugs, is the common condition nowadays. The most common non-iatrogenic
cause of Cushing’s syndrome is Cushing’s disease, referring to a tumor (generally adenoma) in the pituitary gland
produce large amounts of ACTH, causing the adrenal glands to produce elevated levels of cortisol. Less frequent is
Cushing’s syndrome due to primary adrenal disease. The typical features of the Cushing’s syndrome usually allows
an easy diagnosis but many times the clinical picture is much less clear. The current manuscript reports the history
of a woman affected by a very long and overlooked history of hypercortisolism, approximately 10 years. Through the
years it was not possible to confirm adrenal hyperfunction and the patient was treated considering very common
symptoms (obesity, hypertension, osteoporosis). Functional tests and CT imaging finally showed a primitive
functional nodule of the adrenal gland. Laparoscopic adrenalectomy lead to complete regression of the hormonal
excess, with disappearance of classical Cushing’s clinical features. Histology was consistent with a macronodular
hyperplasia showing two well capsulated lesions with respect to the surrounding adrenal tissue