A 53-year-old man was referred to us for evaluating left adrenal incidentaloma. His
morning plasma adrenocorticotropic hormone (ACTH) and serum cortisol (F) levels were
42.5 pg/mL and 30.2 μg/dL, respectively, indicated ACTH-dependent hypercortisolemia.
The patient did not exhibit any Cushingoid features, but had mild gynecomastia (Figure 1). His serum prolactin 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 F levels
(6.0 μg/dL), despite reducing ACTH levels (1.9 pg/mL). His late-night plasma ACTH
and serum F levels were 5.7 pg/mL and 8.0 µg/dL, respectively, indicating autonomous
cortisol secretion. However, urinary free cortisol (UFC) 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.
Figure 1The patient with hypercortisolemia does not exhibit cushingoid features, but rather
mild gynecomastia. Front view (A); side view (B).
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References
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