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Requests for reprints should be addressed to Hidenori Fukuoka, MD, PhD, Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, 7-5-1, Kusunoki, Chuo, Kobe 650-0017, Japan.
A 53-year-old man was referred to us for evaluating left adrenal incidentaloma. His
morning plasma adrenocorticotropic hormone (ACTH) and serum cortisol levels were 42.5
pg/mL and 30.2 μg/dL, respectively, indicating ACTH-dependent hypercortisolemia. The
patient did not exhibit any Cushingoid features, but had mild gynecomastia (Figure). His serum prolactin (PRL) levels were slightly elevated (19.1 ng/mL), whereas estrogen
levels were not (9 pg/mL). His testosterone levels were within the normal range (3.40
ng/mL). The 1-mg overnight dexamethasone suppression test did not suppress serum cortisol
levels (6.0 μg/dL), despite reducing ACTH levels (1.9 pg/mL). His late-night plasma
ACTH and serum cortisol levels were 5.7 pg/mL and 8.0 µg/dL, respectively, indicating
autonomous cortisol secretion. However, urinary free cortisol levels were 45.6 μg/day
(reference range: 11.2-80.3), suggesting no cortisol over-secretion. Although the
serum cortisol levels were high on multiple occasions, his serum electrolytes and
white blood cell fractions were within normal limits. No overt metabolic abnormalities
were observed. All other hormone levels were within normal ranges.
FigureThe patient with hypercortisolemia does not exhibit cushingoid features, but rather
mild gynecomastia. (A) Front view; (B) side view.
