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Adrenocorticotropic Hormone-independent Cushing Syndrome with Right Adrenal Adenoma and HIV Infection: A Case Report

Author(s):

Yuan Yuan, Bingfeng Luo, Xiang Yi, Tuo Liang and Zhenquan Lu*  

Abstract:


Background: Adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome (CS) with right adrenal adenoma combined with HIV infection has rarely been reported.

Case presentation: A 39-year-old Chinese male patient with HIV infection was admitted to our hospital due to increased blood pressure in the previous 2 years and weight gain in the previous 6 months. Endocrinological examinations showed that blood cortisol (8 a.m.) was 22.23 µg/dl, the level of ACTH (8 a.m.) was less than 1pg/ml and twenty-four-hour urinary cortisol was 1429 µg/24h. ACTH-independent CS was diagnosed based on low ACTH levels (<1.00 pg/ml), a lack of cortisol circadian rhythms and unsuppressed cortisol levels by dexamethasone. The ultrasonography and multislice spiral computed tomography scan revealed a right adrenal mass. Due to the HIV status of the patient, we measured the count of CD4+ T helper cells. Laparoscopic right adrenal resection was performed after the CD4+ T helper cell count was > 200 cells/µl. Subsequent immunohistochemical staining confirmed right adrenal adenoma.

Results: The postoperative recovery was good, and wound healing was possible. After surgical treatment, endocrinological examinations indicated that the level of ACTH increased and the levels of serum cortisol and twenty-four-hour urinary cortisol decreased, which indicated that CS was controlled. CD4/CD8 was 0.47 at reexamination, and the patient's immunity was improved.

Conclusion: Due to the potential side effects of steroid drugs, clinicians should use these medications with caution and closely monitor the development of adrenal deficiency.

Keywords:

Adrenal adenoma, Cushing's syndrome, HIV infection, Adrenocorticotropic hormone, Blood pressure, CD4+

Affiliation:

Department of Urology, The University of Hong Kong-Shenzhen Hospital, Shen Zhen 518000, Department of Urology, The University of Hong Kong-Shenzhen Hospital, Shen Zhen 518000, Department of Urology, The University of Hong Kong-Shenzhen Hospital, Shen Zhen 518000, Department of Urology, The University of Hong Kong-Shenzhen Hospital, Shen Zhen 518000, Department of Urology, The University of Hong Kong-Shenzhen Hospital, Shen Zhen 518000



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