RT Journal
A1 Gabriele M, Piero B, Massimo C, Pinuccia F, Paolo M
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2010
FD January 1
VO 145
IS 1
SP 99
OP 99
DO 10.1001/archsurg.2009.242-a
UL http://dx.doi.org/10.1001/archsurg.2009.242-a
AB
A complete evaluation was performed. On physical examination, slight obesity was observed (body mass index, 26.5; calculated as weight in kilograms divided by height in meters squared), without virilization signs. Typical Cushing features such as central obesity, moon facies, purple striae on the lower abdomen, and buffalo bump were absent. Laboratory data, including results of endocrinologic tests, were normal (aldosterone, 4.1 ng/dL [to convert to picomoles per liter, multiply by 27.74]; plasma renin activity in orthostatism, 0.17 μg/L/h; cortisol, 4.89 μg/dL [to convert to nanomoles per liter, multiply by 0.331]; adrenocorticotropic hormone, <5 pg/mL [to convert to picomoles per liter, multiply by 0.22]; dehydroepiandrosterone sulfate, 218.52 μg/dL [to convert to micromoles per liter, multiply by 0.027]) except for slight elevation of blood norepinephrine, which was 410.1 pg/mL (reference value, 400 pg/mL; to convert to picomoles per liter, multiply by 5.911) and urinary normetanephrine, which was 1209.2 μg per 24 h (reference value, <600). A computed tomographic scan confirmed the presence of a 7-cm inhomogeneous mass with calcifications, arising from the right adrenal gland. Irregular central areas representing necrosis and hemorrhage were absent (Figure 1).