[Adrenocortical macronodular hyperplasia with massive enlargement of the gland. A rare variant of autonomous hypercortisolism]. / Hiperplasia macronodular corticosuprarrenal con agrandamiento masivo de la glándula. Una rara variante de hipercortisolismo autónomo.

OBJECTIVE: To present a case of Cushing's syndrome due to massive adrenocortical macronodular hyperplasia that gave the gland the appearance of a pseudotumor. METHODS: In a review of the surgical pathology of the adrenal gland recently performed in our hospital, 82 adrenalectomy specimens obtained from 1978-1998 were found. Of these 82 surgical specimens, 44 (53.6%) were cortical pathologies and 10 of these (12.1%) were hyperplasia. There was only one with massive adrenocortical macronodular hyperplasia. A 53-year-old male, chronic alcoholic with cushingoid obesity and hypercortisolism is described. RESULTS: Ultrasound and CT assessment showed enlarged, asymmetrical adrenal glands and macronodules. The analytical and MRI study of the sella turcica showed primary adrenal hypercortisolism. Adrenalectomy of the dominant gland (the left adrenal whose activity was demonstrated on the 131Iodine scintiscan) was performed. The postoperative cortisol levels returned to normal and remain normal up to the present time, 18 months after surgery. The surgical specimen weighed 104 gms and was completely macronodular. CONCLUSIONS: Massive adrenocortical macronodular hyperplasia is a rare cause of pituitary-independent autonomous primary adrenal hypercortisolism. It is always bilateral. Adrenal weight is significantly increased (total weight of both adrenals 60-180 gms) and present yellow or golden, non-encapsulated nodules of a few millimeters to up to 4 cms, comprised of cells with scanty activity, therefore massive enlargement of the glands is necessary to produce Cushing's syndrome. The clinical, biochemical and surgical aspects can cause confusion and can be suggestive of an adrenocortical neoplasm. Treatment is by adrenalectomy.

Síndrome de secreción ectópica de ACTH "oculto": a propósito de un caso / "Occult" ectopic ECTH syndrome: a case report

Se define el síndrome de secreción ectópica de ACTH "oculto" como el hipercortisolismo dependiente de ACTH de origen extrahipofisario, sin que tras más de 6 meses se descubra su origen. Presentamos una paciente de 55 años diagnosticada de síndrome de Cushing y tratada mediante suprarrenalectomía bilateral en la que se descubre el tumor carcinoide secretor de ACTH 20 años después (AU)

["Occult" ectopic ACTH secretion syndrome: a case report]. / Síndrome de secreción ectópica de ACTH "oculto": a propósito de un caso.

The occult ectopic ACTH syndrome is ACTH-dependent hypercortisolemia of non pituitary origin, and of more than 6 months duration without the diagnosis of the origin. We report a 55 years old woman diagnosed of Cushing syndrome and treated by mean of bilateral adrenalectomy, in which is discovered an ACTH-secreting carcinoid tumor 20 years later.

[An adrenal carcinoma producing androgens, estrogens and cortisol]. / Carcinoma suprarrenal productor de andrógenos, estrógenos y cortisol.

Carcinoma of the adrenal cortex is a fairly rare entity, usually with a somber prognosis. The efficacy of treatment depends on early prognosis. We are reporting here a case of carcinoma of the adrenal cortex producing androgens, estrogens and cortisol, in which diagnosis was not achieved until two years after the onset of symptoms. Morphologic studies by CT showed local extension and metastases. After mass-reduction surgery, the patient died due to respiratory failure. This case remarks the importance of early diagnosis in this syndrome.

Acromegaly and bronchial carcinoid. Effect of removal of the latter.

A patient with a long-standing history of bronchial carcinoid and acromegaly was studied. There was pituitary enlargement with an intrasellar mass (brain computed tomography scan), high basal GH levels, and abnormal GH and other pituitary hormones response to oral glucose and a combined test (LHRH, TRH, insulin). After resection of the bronchial carcinoid, basal GH was normal, GH was normally suppressed during OGTT, pituitary function was within expected normal range, and there was regression of the pituitary tumor together with clinical improvement. These data suggest that the patient's acromegaly was secondary to pituitary stimulation due to the bronchial carcinoid.