A Long-Standing Subtle Cushing's Syndrome Induced by a UnilateralMacronodular Adrenal Hyperplasia

Cushing’s syndrome is a clinical picture characterized by signs and symptoms associated with a prolonged exposure to inappropriately high level of the hormone cortisol. Described for the first time by Harvey Cushing in 1932, iatrogenic cause, by taking drugs, is the common condition nowadays. The most common non-iatrogenic cause of Cushing’s syndrome is Cushing’s disease, referring to a tumor (generally adenoma) in the pituitary gland produce large amounts of ACTH, causing the adrenal glands to produce elevated levels of cortisol. Less frequent is Cushing’s syndrome due to primary adrenal disease. The typical features of the Cushing’s syndrome usually allows an easy diagnosis but many times the clinical picture is much less clear. The current manuscript reports the history of a woman affected by a very long and overlooked history of hypercortisolism, approximately 10 years. Through the years it was not possible to confirm adrenal hyperfunction and the patient was treated considering very common symptoms (obesity, hypertension, osteoporosis). Functional tests and CT imaging finally showed a primitive functional nodule of the adrenal gland. Laparoscopic adrenalectomy lead to complete regression of the hormonal excess, with disappearance of classical Cushing’s clinical features. Histology was consistent with a macronodular hyperplasia showing two well capsulated lesions with respect to the surrounding adrenal tissue