ArticleJCEM case reports2025
Addressing the Clinical Conundrum of Localization in ACTH-independent Cushing Syndrome With Bilateral Adrenal Nodules.
Article in JCEM case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
ACTH-independent Cushing syndrome is commonly caused by a unilateral adrenal adenoma. However, in cases with bilateral adrenal nodules, localization of the functional lesion is challenging. We present the case of a 26-year-old woman with ACTH-independent Cushing syndrome and concurrent bilateral adrenal nodules. Using dexamethasone-suppressed adrenal venous sampling (AVS), an adrenal vein to peripheral vein cortisol ratio >6.5, and an aldosterone-corrected cortisol lateralization ratio >2.3, the autonomous cortisol secretion was localized to the right adrenal adenoma. She underwent a right posterior retroperitoneal laparoscopic adrenalectomy resulting in clinical and biochemical resolution of hypercortisolism. Postoperatively, she required hydrocortisone therapy, which was successfully discontinued after 4 years. The use of dexamethasone-suppressed AVS, in conjunction with aldosterone-corrected cortisol lateralization ratio, may enhance the diagnostic accuracy of AVS.
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