case_images: PMC6749096_01
case_images: Coronal (A) and axial (B,C) views of adrenal CT scan showing bilateral adrenal enlargement with features of mixed BMAH (right; thin arrow) and myelolipoma (particularly on left; short arrow).
case_images: fendo-10-00618-g0001.jpg
case_images: PMC6749096_01_fendo-10-00618-g0001.jpg
case_images: F1
case_images: ACTH levels basally (0.8 pmol/L, N = 2.0-11.0) and the absence of increase of ACTH and cortisol levels following 1 mug/kg CRH IV led to the diagnosis of ACTH-independent Cushing's syndrome. Abdominal CT and MRI studies showed bilateral enlargement of the adrenal glands (R: 6.5 x 3.5 cm, L: 8.0 x 6.9 cm) containing several nodules with heterogeneous features and density (varying from -8 to 30 HU) suggestive of mixed lesion with myelolipoma component, particularly on the left gland, while on the right hypodense regions were less present (Figures 1A-C). 18F-FDG PET-CT scan was not suggestive of malignancy as the maximal SUV was 2.9 in the left adrenal.