Prolonged Hypothalamo - Pituitary - Adrenal Axis Suppression Following Unilateral Adrenalectomy for a Cortisol Secreting Adrenal Adenoma : A Case Report

This article presents a comprehensive exploration of a complex case of Cushing's syndrome in a 29-year-old woman, characterized by significant weight gain, diabetes, and hypertension. The diagnostic journey involves meticulous examination, radiological imaging revealing an adrenal adenoma, and an unexpected twist in the immunohistochemical analysis - diffuse ACTH positivity despite suppressed plasma ACTH levels. This finding challenges conventional understanding and raises questions about paracrine influences. The patient's postoperative course is marked by undetectable serum cortisol levels, indicating successful surgical intervention, yet an unforeseen challenge emerges—prolonged suppression of the hypothalamo-pituitary-adrenal axis. This persistent adrenal axis suppression, even at two years postoperatively, presents a noteworthy and intricate aspect of the case. Through this case study, we aim to contribute valuable insights into the complexities of Cushing's syndrome, emphasizing the importance of recognizing atypical presentations, understanding histological nuances, and addressing the prolonged consequences of adrenal axis suppression.