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Clinical Medicine & Research
Volume 5, Number 4 : 227
doi:10.3121/cmr.2007.754
© 2007 Marshfield Clinic
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The Aperture

Cystic Adrenal Hyperplasia – Diagnosis?

Mrinal M Patnaik, MD and Alaka K Deshpande, MD

*Mrinal M Patnaik, MD, Department of Internal Medicine, University of Minnesota, Minneapolis, MN 55414 USA, Email: mirnal.patnaik{at}gmail.com.
Alaka K Deshpande, MD, Department of Internal Medicine, Grant Medical College and, Sir JJ Hospital, Mumbai, India

* To whom correspondence should be addressed.

Received: February 7, 2007.

Accepted: March 23, 2007.

Key Words: Ascites • Cortisol • Cystic adrenal hyperplasia • Computed tomography

A 20-year-old male from rural India was brought to the hospital with complaints of persistent low-grade fevers, night sweats, weight loss, abdominal distention, multiple episodes of pre-syncope and a generalized failure to thrive. He was found to be hypotensive and had increased pigmentation of the skin (especially the palms and the oral mucosa). He had free fluid in the abdomen without organomegaly, lumps or masses. He had normal external genitalia and secondary sexual characteristics. His chest x-ray was normal. His laboratory work-up revealed an ESR of 90 mm and a random serum cortisol of <4 mg/dl. A computed tomography (CT) scan of the abdomen and pelvis showed the presence of bilateral cystic adrenal hyperplasia with preserved contours, and evidence of free fluid in the abdomen. There was no abdominal, retroperitoneal lymphadenopathy or thickening of the ileo-caecal region. An abdominal paracentesis revealed the fluid to be exudative with a negative gram stain and AFB stain. Of note, the ascitic fluid ADA (adenosine deaminase level) was elevated at 75 U/ml. He did not have any electrolyte abnormalities and his HIV ELISA was negative. The CT scan of his abdomen is shown in figure 1Go. What is your diagnosis?


Figure 1
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  		Figure 1. CT scan showing bilateral cystic adrenal hyperplasia.

 
What is your diagnosis?

Diagnoses may be submitted via email (clinmedres{at}mcrf.mfldclin.edu) or fax (715-389-3808). The authors’ diagnosis will be published in March 2008.




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