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Kim, Kim, Ryu, Nam, Lee, Koh, Shin, Jung, and Chung: A Case of Adrenocortical Adenoma Causing Subclinical Cushing's Syndrome Mistaken for Liddle's Syndrome
Case Report
Journal of Korean Society of Endocrinology

Journal of Korean Society of Endocrinology 2006; 21(1): 58-62.

Published online: 20 February 2006

DOI: https://doi.org/10.3803/jkes.2006.21.1.58

A Case of Adrenocortical Adenoma Causing Subclinical Cushing's Syndrome Mistaken for Liddle's Syndrome

Kyu Hong Kim, Kwang Hyun Kim, Ho Yoel Ryu, Soo Min Nam, Mi Young Lee, Jang Hyun Koh, Jang Yel Shin, Soon Hee Jung1, Choon Hee Chung

Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

1Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea.

Received 29 June 2005       Accepted 8 January 2006

Copyright © 2006 Korean Endocrine Society

Abstract

Subclinical Cushing's syndrome is defined as an autonomous cortisol hyperproduction without specific clinical signs of cortisol excess, but detectable biochemically as derangements of the hypothalamic-pituitary-adrenal axis function. We report a case of a 33-year-old woman with subclinical Cushing's syndrome caused by left adrenocortical adenoma, mistaken for Liddle's syndrome. The patient complained of fatigue. Laboratory findings showed metabolic alkalosis, hypokalemia, high TTKG (transtubular K concentration gradient), low plasma renin activity, and low serum aldosterone level, that findings implied as Liddle's syndrome. So we performed further study. Hormonal and radiologic studies revealed subclinical Cushing's syndrome with a left adrenal mass. The adrenal mass was resected and pathologically diagnosed as adrenocortical adenoma. After the resection of the left adrenal mass, patient's hormonal levels showed normal range.

Keywords: Adrenocortical adenoma, Liddle's syndrome, Subclinical Cushing's syndrome

Figures and Tables

Fig. 1
Computed tomography of the abdomen showing 3 × 2 cm sized, oval shaped left adrenal mass.
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Fig. 2
Whole body scans were obtained 3 days (A), 5 days (B), 7 days (C) after injection of I-131 NP59 1 mCi. Adrenal scan [59-[131I]iodocholesterol scanning (NP59 scan)] showed nodular activity in the region of left adrenal gland.
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Fig. 3
The tumor (3.2 × 3 × 2 cm sized) is well-circumscribed and bright yellow in color.
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Fig.4
Microscopic finding of the tumor. (A) The tumor is well defined and composed of clear cells and eosinophilic cells (H & E stain, × 20). (B) The tumor cells have abundant clear cytoplasm and a small round nucleus (H & E stain, × 200).
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Table 1
Hormonal Profiles in this Patient
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Table 2
Hormonal Profiles Change after Operation in this Patient
jkse-21-58-i002

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