Table of Contents Author Guidelines Submit a Manuscript
Case Reports in Endocrinology
Volume 2013 (2013), Article ID 706989, 4 pages
http://dx.doi.org/10.1155/2013/706989
Case Report

Endogenous Cushing’s Syndrome with Precocious Puberty in an 8-Year-Old Boy due to a Large Unilateral Adrenal Adenoma

1Department of Medicine, Shaheed Suhrawardy Medical College Hospital, Sher-e-Bangla Nagar, Dhaka 1207, Bangladesh
2Department of Pediatrics, Dhaka Medical College Hospital, 100 Ramna, Dhaka 1000, Bangladesh
3Department of Surgery, Shaheed Suhrawardy Medical College Hospital, Sher-e-Bangla Nagar, Dhaka 1207, Bangladesh

Received 3 January 2013; Accepted 13 February 2013

Academic Editors: M. T. Garcia-Buitrago, H. Hattori, H. Kang, and N. Sakane

Copyright © 2013 Muhammad Rajib Hossain et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Adrenocortical tumors (ACTs) causing Cushing’s syndrome are extremely rare in children and adolescents. Bilateral macronodular adrenocortical disease which is a component of the McCune-Albright syndrome is the most common cause of endogenous Cushing’s syndrome. We report the case of a boy with Cushing’s syndrome who presented with obesity and growth retardation. The child was hypertensive. The biochemical evaluation revealed that his serum cortisol levels were 25.80  g/dL, with a concomitant plasma ACTH level of 10.0 pg/mL and nonsuppressed serum cortisol on high-dose dexamethasone suppression test (HDDST) to be 20.38 g/dL. Computed tomography of the abdomen demonstrated a 8 × 6 × 5 cm left adrenal mass with internal calcifications. Following preoperative stabilization, laparotomy was carried out which revealed a lobulated left adrenal mass with intact capsule weighing 120 grams. Histopathological examination revealed a benign cortical neoplastic lesion, suggestive of adrenal adenoma; composed of large polygonal cells with centrally placed nuclei and prominent nucleoli without capsular and vascular invasion. On the seventh postoperative day, cortisol levels were within normal range indicating biochemical remission of Cushing’s syndrome. On followup after three months, the patient showed significant clinical improvement and had lost moderate amount of weight and adrenal imaging was found to be normal.