Bilateral Nodular Adrenal Hyperplasia


Question

I have a patient with bilateral nodular adrenal hyperplasia,.mildly elevated cortisol,but well apart from well controlled diabetes. What do I do ?

Surgery,medical therapy eg ketoconazole, nothing? Thanks. Steven Harris

Response

Just having slightly enlarged nodular adrenals is not in itself a disease, and has to be seen in biochemical context. I would perform a dexamethasone suppression test for cortisol, preferably the full 2-day test, and measure plasma ACTH and 17-OH-progesterone. Assuming the patient suppresses their serum cortisol to <50 nmol/l and the 17-OH-P is normal, then I would do nothing. If the patient fails to suppress and the ACTH is readily detectable they will need a work-up for Cushing's disease. If the ACTH is undetectable then this may be a form of primary nodular adrenal disease and should be considered for medical-blocking therapy in the first instance followed by consideration of adrenalectomy. In general, if the patient is 'well' I would be more inclined to do less rather than more. Ashley Grossman, MD