Oncocytic Adrenocortical Carcinoma
The Weiss scoring system is the most popular system used in the histologic diagnosis of adrenocortical carcinoma (ACC) and includes assessment of diffuse architecture; clear cells; nuclear grade; mitotic rate;…
ENDOCRINOLOGY
Unexpected Diagnosis of Adrenal Cortical Carcinoma: Role of Urinary Steroid Profiling
Adrenal “incidentaloma” is frequently ignored by clinicians. However, approximately 50% of all patients with adrenocortical carcinomas (ACCs), pheochromocytomas, and overt hormone excess are discovered incidentally. When imaging characteristics of the…
Adrenal Cortical Carcinoma in a Patient With a History of Adrenal Incidentaloma
When a patient is incidentally discovered with an adrenal mass, two questions need to be answered: (1) Is the adrenal mass malignant? (2) Is the adrenal mass hormonally active? Age,…
Carney Triad (Pentad) and Adrenal Adenoma With Clinically Important Cortisol Secretory Autonomy
Carney triad (described in 1977) is a rare, nonfamilial, multitumoral syndrome, with three tumors in the initial description: gastrointestinal stromal tumor (GIST), pulmonary chondroma, and extraadrenal paraganglioma. Subsequently, two other…
Corticotropin-Independent Cushing Syndrome in a Patient With “Normal” Adrenal Imaging
The diagnosis of corticotropin (ACTH)-independent hypercortisolism with adrenal imaging that does not demonstrate unilateral or bilateral nodules should prompt consideration of bilateral micronodular hyperplasia (Table C.2). Primary pigmented nodular adrenocortical…
35-Year-Old Woman With Low Bone Density and Fractures
Symptoms of overt glucocorticoid excess should prompt appropriate biochemical and imaging workup. In this case, despite imaging characteristics of myelolipoma and contralateral adrenal gland without abnormalities, ipsilateral adrenal adenoma was…
66-Year-Old Woman With Corticotropin-Independent Hypercortisolism and Bilateral Macronodular Adrenal Hyperplasia
Bilateral macronodular adrenal hyperplasia (BMAH) is an uncommon cause of adrenal hypercortisolism. It is a progressive disease that may present with a spectrum of cortisol and aldosterone secretion. BMAH can…
45-Year-Old Woman With Corticotropin-Independent Cushing Syndrome and Bilateral Adrenal Adenomas
## Management of corticotropin (ACTH)-independent hypercortisolism in patients with bilateral adrenal nodules depends on imaging findings (adenomas versus macronodular hyperplasia) and tumor size. Adrenal venous sampling (AVS) is useful in…
Primary Aldosteronism: When Adrenal Venous Sampling Shows Suppressed Aldosterone Secretion From Both Adrenal Glands
## It is a curious conundrum when adrenal venous sampling (AVS) is performed in a patient with primary aldosteronism (PA) and the aldosterone concentrations from both successfully sampled adrenal veins…
26-Year-Old Woman With a Discrepant Workup for Cushing Syndrome Subtype
## Establishing corticotropin (ACTH) dependence is a crucial step in the diagnostic evaluation of hypercortisolism and relies on measurement of ACTH. In ACTH-dependent hypercortisolism, pituitary magnetic resonance imaging (MRI) is…
