Adrenal hyperplasia, either diffuse or nodular, accounts for approximately 80% of all cases of Chusing's syndrome while cortical adenoma and carcinomas comprise the rmainder. Bilateral nodular hyperplasia accounts for between 155 to 20 T of all
cases of
hyperplasia. Very rarely, noular hyperplasia has been reported to involve one gland. Futhermore, the clinical differential diagnosis of unilateral nodular hyperplasia from cortical adenoma or carcinoma has been known to by very difficult.
We report a cases of nodular hyperplasia with primary hypercortisolism involving only right adrental gland. The patient was a 41 year-old male with complaints of generalized fatigue and weakness for 2 months. On magnetic resonance imaging (MRI),
an
irregular solid mass of right adrenal gland, 4.7×4.3×4.2 cm, was found. Biochemical evaluation reveals increased plasma cortisol, 24-hour urine free cortisol, and 17-hydroxycorticosteroid (17-OHCS.) In contrast, plasma ACTH level and
dihydroepiandrosterone sulfate (DHEA-S) were decreased and overnight dexamethasone suppression test was equivocal.
Right adrenalectomy was done.
Grossly, the surgically removed gland weighed 23 gm. On the cut section, variable sized yellowish brown nodules, up to 2cm, were found. There no necroses except focal hemorrhge. Microscopically, each nodule was composed of large, lipid-laden
clear
cells
and compact cells with eosinophilic cytoplasm.
Neither nulear or cellular pleomorphism was evident. Mitotic figures were very rare. Internodular fibrous septa revealed hyperplastic cortical cells and collagen fibers. Thus, there was no evidence of cortical atrophy.
Ultrastructurally, the nodule is composed of two types of round or oval cells. The clear cells had numerous lipid dreoplets but sparse organelle in the cytoplasm. The compact cells showed nuumerous smooth endoplasmic reticulum(SER), and
mitochondria
with tubulovesicular crsitae. Also, a few stacks of rough endoplasmic reticulum, some lysosomes and myelin figures in the cytoplasm were observed.
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