A Case of ACTH-independent Macronodular Adrenal Hyperplasia

Bilateral macronodular adrenal hyperplasia (BMAH) is rare cause of Cushing syndrome characterized by enlarged adrenal gland containing multiple nodule which is greater than 10 mm and can reach 30-40 mm. Recently many study suggest that hypercortisolism in BMAH is due to the expression of ectopic horrmone receptor like gastric inhibitory polypeptide, vasopressin, catecholamine or overexpression of eutopic receptor on adrenal glands. Also genetic studies showed that BMAH caused by several somatic gene mutation during the embryogenesis and inherited germline mutation. We report 54 years old man who has Cushing syndrome due to BMAH with a negative response to aberrant hormone receptor test. We performed laparoscopic bilateral adrenalectomy. Both leg edema disappeared and serum cortisol level became to normal after the operation.