Chan Soo Ling, Chatterjea Rhea, Cheah Wei Keat, Oh Han Boon
Department of Medicine, Ng Teng Fong General Hospital, Singapore 609606, Singapore.
Department of Surgery, Ng Teng Fong General Hospital, Singapore 609606, Singapore.
JCEM Case Rep. 2025 Sep 24;3(10):luaf192. doi: 10.1210/jcemcr/luaf192. eCollection 2025 Oct.
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.
促肾上腺皮质激素（ACTH）非依赖性库欣综合征通常由单侧肾上腺腺瘤引起。然而，在双侧肾上腺结节的病例中，功能性病变的定位具有挑战性。我们报告一例26岁患有ACTH非依赖性库欣综合征并伴有双侧肾上腺结节的女性病例。使用地塞米松抑制肾上腺静脉采血（AVS），肾上腺静脉与外周静脉皮质醇比值>6.5，以及醛固酮校正皮质醇侧化率>2.3，自主皮质醇分泌定位于右侧肾上腺腺瘤。她接受了右后腹膜后腹腔镜肾上腺切除术，高皮质醇血症在临床和生化方面得到缓解。术后，她需要氢化可的松治疗，4年后成功停用。结合醛固酮校正皮质醇侧化率使用地塞米松抑制AVS，可能会提高AVS的诊断准确性。
