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

• Published in: Current HIV research Vol. 19; no. 5; p. 460
• Main Authors: Yuan, Yuan, Luo, Bingfeng, Yi, Xiang, Liang, Tuo, Lu, Zhenquan
• Format: Journal Article
• Language: English
• Published: Netherlands 01.01.2021
• Subjects: Adenoma - complications; Adenoma - diagnosis; Adenoma - surgery; Adrenocorticotropic Hormone; Adult; Cushing Syndrome - diagnosis; Cushing Syndrome - etiology; HIV Infections - complications; Humans; Hydrocortisone; Male; blood pressure; CD4; Cushing's syndrome; Adrenal adenoma; HIV infection; adrenocorticotropic hormone
• ISSN: 1873-4251
• DOI: 10.2174/1570162X19666210614124543

Adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome (CS) with right adrenal adenoma combined with HIV infection has rarely been reported. 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. 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. Due to the potential side effects of steroid drugs, clinicians should use these medications with caution and closely monitor the development of adrenal deficiency.