ASAP Live - Pituitary, Adrenal & Neuroendocrine-Pituitary Adrenal PowerPoint

Pituitary Adrenal PowerPoint

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A 65-year-old woman with a history of type 2 diabetes, hypertension, and multiple myeloma underwent a positron emission tomography/computed tomography (PET/CT) scan that revealed bilateral adrenal nodules. The nodules, which were stable in size over a 3-year period, were found to be macroadenomas. The patient's hormone levels were evaluated to determine functionality, and it was discovered that her aldosterone level was slightly elevated and her renin level was nonsuppressed, indicating possible autonomous cortisol production. These findings are consistent with a diagnosis of bilateral macronodular adrenal hyperplasia (BMAH). <br /><br />In BMAH, the adrenal glands become enlarged and nodular, with cortisol secretion being partially regulated by aberrant G protein–coupled receptors. This leads to the activation of the cyclic adenosine monophosphate/protein kinase A signaling pathway, resulting in the transcription of steroidogenic factors and autonomous cortisol production. BMAH is often associated with mild relative deficiency of 21-hydroxylase expression.<br /><br />Distinguishing BMAH from other conditions, such as congenital adrenal hyperplasia, pheochromocytoma, or metastatic adrenal disease, is crucial. In this case, the incomplete suppression of cortisol after dexamethasone administration and the undetectable adrenocorticotropic hormone (ACTH) level help differentiate BMAH from congenital adrenal hyperplasia. The absence of plasma metanephrine presence rules out pheochromocytoma, and the lack of evidence of progressing bone lesions and distant extramedullary involvement suggests that the adrenal nodules are not due to metastatic disease from multiple myeloma.<br /><br />The management for BMAH typically involves close observation with regular imaging and hormonal assessments.

Keywords

bilateral adrenal nodules

macroadenomas

aldosterone level

renin level

autonomous cortisol production

bilateral macronodular adrenal hyperplasia

aberrant G protein–coupled receptors

cyclic adenosine monophosphate/protein kinase A signaling pathway

congenital adrenal hyperplasia

pheochromocytoma