Unilateral adrenalectomy for primary pigmented nodular adrenocortical disease may not prevent long-term complications of Cushing's syndrome due to persistent loss of circadian cortisol rhythm.
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May warrant lifelong cortisol rhythm surveillance after unilateral adrenalectomy in Cushing syndrome; leaves open optimal strategies to restore circadian control.
A 45-yr-old man with primary pigmented nodular adrenocortical disease (PPNAD) is described. This patient underwent unilateral adrenalectomy for ACTH-independent Cushing's syndrome (CS) in 1969. Although his daily urinary free cortisol (UFC) excretion rate normalized, and the major clinical manifestations of CS subsided, loss of a circadian cortisol rhythm persisted after surgery. Twenty-seven years later, the patient presented again with short stature, severe osteopenia, skeletal deformities, thinning of the skin, and myopathy.
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Sarlis et al. (1997) studied this question.
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