Bilateral adrenal tumors presenting with cushing syndrome in the setting of horseshoe kidney - surgical and urological considerations: case report

Simultaneous bilateral adrenal masses are less common in patients with Cushing syndrome (CS). This case report focuses on the clinical features, diagnostic workup, and treatment of a patient with bilateral adrenal tumors causing Cushing syndrome, with a horseshoe kidney. We report a case of bilateral adrenal tumors presenting with Cushing syndrome with a horseshoe kidney. Adrenalectomy was undertaken to manage the excess cortisol. Histopathological evaluation confirmed the diagnosis of adrenal cortical carcinoma (ACC). The preoperative cortisol level was 1750 nmol/L, which dropped significantly to 476 nmol/L following the treatment, showing clinical improvement, with a gradual regression of Cushing syndrome symptoms. A three-month postoperative evaluation revealed cortisol levels of 143 nmol/L. Surgical resection of these tumors has the potential to significantly improve clinical outcomes and alleviate the manifestations of Cushing syndrome.