Missed Ipsilateral Adrenal Adenoma With Recurrent Hypercortisolism After Prior Left Adrenalectomy

A 42-year-old woman with history of diabetes mellitus (DM), hyperlipidemia and subclinical hypercortisolism with previous left adrenalectomy was admitted for the evaluation of recurrent hypercortisolism due to gain of weight (8 kg over 3 months).1 The woman was on oral diabetic and hypertension medication (metformin, glimepiride, losartan, and amlodipine), without exposure of exogenous glucocorticoid. The woman had no familial history of hypercortisolism. Plasma ACTH levels at 8 A.M. and 4 P.M. were within normal range (16.2 pg/mL and 18.0 pg/mL, respectively), but 24-hour urine free cortisol was elevated (760.5 μg/day). A 3 × 2 cm mass on lower surgical bed level of previously resected left adrenal region was found in abdominal CT and showed increased uptake in 131I-iodocholesterol (NP-59) scan. Suggestive of adrenocortical adenoma, left adrenal mass was resected and pathology was concordant with adrenocortical adenoma.