Cushing's syndrome caused in a case of adrenocortical hyperplasid associated with a solitary adrenal adenoma

A 41-year-old male presented with a history of Cushing’s syndrome for 3 years.His baseline serum cortisol levels were elevated and lacked a normal circadian rhythm.Dynamic testing of pituitary-adrenal function revealed positive responses to sythetic ACTH infusion and no suppression with low or high doses of dexamethasone.Tomography of the sella turcica was normal. Retroperitoneal gas insufflation showed enlarged adrenals,suggesting bilateral adrenal hyperplasia. His left adrenal was totally removed and confirmed to be pathologically.On exploration of the right adrenal a nodule.3.5×3×2.8cm in size,was enucleated.Which was demonstrated to be adrenal adenoma pathological.After operation the patient’s condition improved clinically.His blood pressure and urinary 17-OHCS returned to normal.The pathogenesis and diagnosis of Cushing’s syndrome in this particular case were discussed in the paper.