Cushing's Syndrome With Multinodular Adrenal Glands*

A case of Cushing's syndrome in a 15-year-old girl with symptoms of one year's duration, is described. The levels of plasma and urinary 17-hydroxycorticostcroids and urinary 17-ketogenic steroids were elevated but the levels of urinary 17-ketosteroids and pregnanetriol were normal. Stimulation with ACTH produced a low, sluggish response in the concentration of plasma 17-hydroxycorticosteroids and only minimal changes in urinary steroids. Administration of 9α-fluorohydrocortisone produced no change in urinary steroid excretion. Following bilateral adrenalectomy the manifestations of Cushing's syndrome disappeared. The adrenals showed diffuse multinodularity of the inner cortex. The relation of this lesion to other adrenal lesions producing Cushing's syndrome is discussed. MELLINGER and Smith in 1956 reported an unusual case of Cushing's syndrome of about thirty years' duration in a patient who had multiple small nodules throughout the cortex of one adrenal. Biopsy of the same gland earlier in the course of the disease had not shown this lesion (1). The contralateral gland was not atrophic and did not show the nodular change. The nodular adrenal pattern was believed to be peculiar to very long-standing Cushing's syndrome.