Abstract
A 64-year-old man with cushingoid features was found to have bilateral nodular adrenal masses (left > right). Laboratory studies showed elevated 24-hour urinary free cortisol level at 64 μg (reference range, 0-50 μg), abnormal levels for the 1-mg dexamethasone suppression test (cortisol, 4.8 μg/dL; dexamethasone level, 665 ng/dL), and suppressed adrenocorticotropic hormone (ACTH) and dehydroepiandrosterone levels. ACTH-independent Cushing syndrome was diagnosed. He was treated with ketoconazole for 6 years, but owing to worsening symptoms including uncontrolled type 2 diabetes mellitus, bilateral adrenalectomy was performed.
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