Simultaneous pituitary and adrenal adenomas in a patient with non ACTH dependent Cushing syndrome; a case report with literature review

• Published in: International journal of surgery case reports 2022-05, Vol.94, p.107038-107038, Article 107038
• Main Authors: Ahmed, Shaho F., Bapir, Rawa, Fattah, Fattah H., Mahmood, Aras Gh, Salih, Rawezh Q., Salih, Abdulwahid M., Tahir, Soran H., Kakamad, Fahmi H.
• Format: Article
• Language: English
• Subjects: Adrenal adenoma; Case Report; Cushing syndrome; Cushing's disease; Pituitary adenoma; Urine free cortisol
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2022.107038

Cushing syndrome is a rare disorder with a variety of underlying etiologies, that can be exogenous or endogenous (adrenocorticotropic hormone (ACTH)-dependent or ACTH-independent). The current study aims to report a case of ACTH-independent Cushing syndrome with adrenal adenoma and nonfunctioning pituitary adenoma. A 37–year–old female presented with amenorrhea for the last year, associated with weight gain. She had a moon face, buffalo hump, and central obesity. A 24-hour urine collection for cortisol was performed, revealed elevated cortisol. Cortisol level was non-suppressed after administering dexamethasone. MRI of the pituitary region revealed a pituitary microadenoma, and the CT scan of the abdomen with adrenal protocol revealed a left adrenal adenoma. Early diagnosis may be postponed due to the variety of clinical presentations and the referral of the patient to different subspecialists based on their dominant symptoms (gynecological, dermatological, cardiovascular, psychiatric); it is, therefore, critical to consider the entire clinical presentation for correct diagnosis. Due to the diversity in the presentation of CS, an accurate clinical, physical and endocrine examination is always recommended. •Cushing syndrome (CS) is a rare disorder with a variety of underlying etiologies.•CS is expected to affect 0.2 to 5 people per million per year.•Adrenal-dependent CS is an uncommon variant of CS.•This study reports a rare occurrence of pituitary and adrenal adenoma with CS.