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Case Reports
. 2020 Jul 15;59(14):1731-1734.
doi: 10.2169/internalmedicine.4180-19. Epub 2020 Apr 2.

Ectopic Cortisol-producing Adrenocortical Adenoma Detected by 131I-6β-iodomethyl-norcholesterol Scintigraphy

Seisuke Sato  1 , Hitomi Imachi  1 , Toshihiro Kobayashi  1 , Kensaku Fukunaga  1 , Jingya Lyu  1 , Tao Dong  1 , Yuuki Yoshioka  1 , Takanobu Saheki  1 , Youko Fukata  1 , Natsuki Ban  1 , Kurumi Urushihara  1 , Kyuuichi Kadota  2 , Koji Murao  1
Affiliations
Case Reports

Ectopic Cortisol-producing Adrenocortical Adenoma Detected by 131I-6β-iodomethyl-norcholesterol Scintigraphy

Seisuke Sato et al. Intern Med. .

Abstract

A 50-year-old man was referred to our department for overt Cushing's syndrome (CS). His plasma cortisol concentrations were 314 μg/L, and his urinary cortisol concentrations were 431 μg/day. The plasma adrenocorticotropic hormone (ACTH) concentration was below the detectable limit. Computed tomography revealed atrophy of both adrenal glands and the presence of a left pararenal tumor. 131I-6β-iodomethyl-norcholesterol scintigraphy showed an intense uptake by the left pararenal tumor. These findings suggested that the left pararenal tumor was ectopic cortisol-producing adrenocortical adenoma. This case serves as a reminder that 131I-6β-iodomethyl-norcholesterol scintigraphy is an effective method for diagnosing ACTH-independent CS in which no adrenal tumor has been found.

Keywords: Cushing's syndrome; cortisol-producing adrenocortical adenomas; ectopic adrenocortical adenoma; scintigraphy.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
A: Coronal section of CT showing that both adrenal glands were normal, and an unknown tumor was found in the left renal hilus. White arrows: normal adrenal gland, red arrow: pararenal tumor. B, C: Axial section of CT and 131I-6β-iodomethyl-norcholesterol scintigraphy. 131I-6β-iodomethyl-norcholesterol scintigraphy showing an intense uptake by the left pararenal tumor. D: Planar image of 131I-6β-iodomethyl-norcholesterol scintigraphy.
Figure 2.
Figure 2.
A, B: The removed tissue is covered with adipose tissue; the brown part is tissue of the ectopic CPA. C: Hematoxylin and Eosin staining of the tumor. D: Immunostaining of CYP17A1.
See this image and copyright information in PMC

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