Remisión del hipercortisolismo tras suprarrenalectomía unilateral en paciente con enfermedad de Cushing persistente e hiperplasia adrenal macronodular

Abstract

A 22 years old female patient was initially referred to our department in January 1997 with symptoms and signs consistent with hypercortisolism. The basal hormonal study and functional testing and imaging oriented towards a pituitary origin. An inferior sinus petrosus venous sampling after CRH stimulus confirmed the pituitary origin of ACTH hypersecretion. After transsphenoidal resection of a pituitary microadenoma, analytical and clinical remission was achieved, with relapse three years later, so a new transsphenoidal surgery was performed and stereotactic fractionated radiation therapy was administered. In subsequent years, cortisol hypersecretion persisted, requiring continued medical treatment with increasing doses of adrenolitic drugs. In its evolution, ACTH levels showed a downward trend and abdominal CT scan showed a hypodense mass of 21 x 41 mm in the left adrenal. Iodocholesterol scan also showed increased uptake at this level. Based on these findings and given the persistence of hypercortisolism, left adrenalectomy was ultimately carried out by laparoscopic surgery in May 2008. After this new surgery, signs and symptoms of hypercortisolism improved markedly, and glucocorticoid replacement was needed. Although in this case the functional autonomy of the nodule is not firmly established, the efficacy of unilateral adrenalectomy is clear.