Affiliation:
1. Department of Urology, The University of Hong Kong-Shenzhen Hospital, Shen Zhen 518000, China
Abstract
Background:
Adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome
(CS) with right adrenal adenoma combined with HIV infection has rarely been reported.
Case presentation:
A 39-year-old Chinese male patient with HIV infection was admitted to our
hospital due to increased blood pressure in the previous 2 years and weight gain in the previous 6
months. Endocrinological examinations showed that blood cortisol (8 a.m.) was 22.23 μg/dl, the
level of ACTH (8 a.m.) was less than 1pg/ml and twenty-four-hour urinary cortisol was 1429
μg/24h. ACTH-independent CS was diagnosed based on low ACTH levels (<1.00 pg/ml), a lack of
cortisol circadian rhythms, and unsuppressed cortisol levels by dexamethasone. The ultrasonography
and multislice spiral computed tomography scan revealed a right adrenal mass. Due to the HIV
status of the patient, we measured the count of CD4+ T helper cells. Laparoscopic right adrenal resection
was performed after the CD4+ T helper cell count was > 200 cells/μl. Subsequent immunohistochemical
staining confirmed right adrenal adenoma.
Results:
The postoperative recovery was good, and wound healing was possible. After surgical
treatment, endocrinological examinations indicated that the level of ACTH increased and the levels
of serum cortisol and twenty-four-hour urinary cortisol decreased, which indicated that CS was controlled.
CD4/CD8 was 0.47 at reexamination, and the patient's immunity was improved.
Conclusion:
Due to the potential side effects of steroid drugs, clinicians should use these medications
with caution and closely monitor the development of adrenal deficiency.
Publisher
Bentham Science Publishers Ltd.
Subject
Virology,Infectious Diseases