The development of bilateral adenomatous adrenal hyperplasia in a case of Cushing's syndrome of eighteen years' duration

Abstract

A case of Cushing's syndrome of eighteen years' duration is presented. The disease began when the patient was eight years old and was partially controlled by pituitary radiation when she was thirteen. However, clinical evidence indicated low grade but continuous adrenocortical activity for the next thirteen years. The probable suppression of growth hormone secretion by the increased steroid levels during her growth period provides a reasonable explanation for the dwarfism of the patient. The administration of 8 mg. of dexamethasone per day failed to decrease urinary steroid excretion. Bilateral nodular hyperplasia was found at surgery. It is suggested from the evidence presented that this patient's disease began first as a primary pituitary process but during the long duration of the ACTH secretion it evolved into one of autonomouslyfunctioning bilateral nodular hyperplasia.