Remission of Cushing's Syndrome after Unilateral Adrenalectomy under the Identification of NP- 59 SPECT/CT in a Patient with Primary Bilateral Macronodular Adrenal Hyperplasia: A Case Report

Abstract

Primary bilateral macronodular adrenal hyperplasia (BMAH) with Cushing's syndrome presenting as resistant hypertension is a relatively rare disease. Bilateral adrenalectomy is the main treatment, but unilateral adrenalectomy for the larger gland has been reported to be a safe and effective alternative. Compared with bilateral adrenalectomy, unilateral adrenalectomy demonstrates the advantage of lower risk of adrenal crisis and no need for lifelong corticosteroid supplements. However, regarding long-term remission in BMAH with Cushing's syndrome, determining which adrenal gland to remove is a clinical dilemma. Recently, the role of adrenocortical scintigraphy in BMAH for functional localization of adrenal glands has been renewed. We report an elderly case of BMAH with Cushing's syndrome presenting as resistant hypertension; right adrenalectomy was performed under the identification of 131I-6β- iodomethyl-norcholesterol (NP-59) single-photon emission computed tomography (SPECT)/computed tomography (CT). During 8 follow-up months, he experienced remission of Cushing's syndrome and his blood pressure has been well under control. In addition, he did not suffer from postoperative adrenal insufficiency and required no hormone replacement therapy, postoperatively. Unilateral adrenalectomy under the identification of noninvasive NP-59 SPECT/CT is a safe and useful treatment for elderly BMAH patients with Cushing's syndrome.