Simultaneous pituitary and adrenal adenomas in a patient with non ACTH dependent Cushing syndrome; a case report with literature review

Shaho F Ahmed; Rawa Bapir; Fattah H Fattah; Aras Gh Mahmood; Rawezh Q Salih; Abdulwahid M Salih; Soran H Tahir; Fahmi H Kakamad

doi:10.1016/j.ijscr.2022.107038

Simultaneous pituitary and adrenal adenomas in a patient with non ACTH dependent Cushing syndrome; a case report with literature review

Int J Surg Case Rep. 2022 May:94:107038. doi: 10.1016/j.ijscr.2022.107038. Epub 2022 Apr 5.

Authors

Shaho F Ahmed¹, Rawa Bapir², Fattah H Fattah³, Aras Gh Mahmood¹, Rawezh Q Salih⁴, Abdulwahid M Salih³, Soran H Tahir³, Fahmi H Kakamad⁵

Affiliations

¹ Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.
² Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq; Sulaimani Teaching Hospital, Sulaimani, Iraq.
³ Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.
⁴ Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq.
⁵ Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq. Electronic address: fahmi.hussein@univsul.edu.iq.

Abstract

Introduction: Cushing syndrome is a rare disorder with a variety of underlying etiologies, that can be exogenous or endogenous (adrenocorticotropic hormone (ACTH)-dependent or ACTH-independent). The current study aims to report a case of ACTH-independent Cushing syndrome with adrenal adenoma and nonfunctioning pituitary adenoma.

Case report: A 37-year-old female presented with amenorrhea for the last year, associated with weight gain. She had a moon face, buffalo hump, and central obesity. A 24-hour urine collection for cortisol was performed, revealed elevated cortisol. Cortisol level was non-suppressed after administering dexamethasone. MRI of the pituitary region revealed a pituitary microadenoma, and the CT scan of the abdomen with adrenal protocol revealed a left adrenal adenoma.

Discussion: Early diagnosis may be postponed due to the variety of clinical presentations and the referral of the patient to different subspecialists based on their dominant symptoms (gynecological, dermatological, cardiovascular, psychiatric); it is, therefore, critical to consider the entire clinical presentation for correct diagnosis.

Conclusion: Due to the diversity in the presentation of CS, an accurate clinical, physical and endocrine examination is always recommended.

Keywords: Adrenal adenoma; Cushing syndrome; Cushing's disease; Pituitary adenoma; Urine free cortisol.