case_images: PMC7484682_01
case_images: Adrenal CT scan of the index patient.
case_images: CRIE2020-8848151.001.jpg
case_images: PMC7484682_01_CRIE2020-8848151.001.jpg
case_images: fig1
case_images: A 64-year-old man, referred to endocrinology due to bilateral adrenal incidentalomas on a CT scan, measuring 4 x 4.3 cm on the left and 4.3 x 4.2 cm on the right side, with characteristics of adenoma/hyperplasia (Figure 1).
case_images: PMC7484682_02
case_images: (H&E, original magnification x2.5)-Histologically, there is evidence of adrenal cortex thickening, with architectural disorganization and multinodular appearance.
case_images: CRIE2020-8848151.002.jpg
case_images: PMC7484682_02_CRIE2020-8848151.002.jpg
case_images: fig2
case_images: These aspects were consistent with adrenal nodular hyperplasia (Figures 2-5).
case_images: (H&E, original magnification x4 and x10)-There is ill-defined multinodular hyperplasia of the cortical fasciculata layer of the adrenal tissue.
case_images: CRIE2020-8848151.003.jpg
case_images: PMC7484682_02_CRIE2020-8848151.003.jpg
case_images: fig3
case_images: These aspects were consistent with adrenal nodular hyperplasia (Figures 2-5).
case_images: H&E, original magnification x4 and x10)-There is ill-defined multinodular hyperplasia of the cortical fasciculata layer of the adrenal tissue.
case_images: CRIE2020-8848151.004.jpg
case_images: PMC7484682_02_CRIE2020-8848151.004.jpg
case_images: fig4
case_images: These aspects were consistent with adrenal nodular hyperplasia (Figures 2-5).
case_images: (H&E, original magnification x20)-The hyperplastic cortical fasciculata layer is characterized by a large number of cord organized cells with well-defined membranes, clear and vacuolated cytoplasm and, small nuclei.
case_images: CRIE2020-8848151.005.jpg
case_images: PMC7484682_02_CRIE2020-8848151.005.jpg
case_images: fig5
case_images: These aspects were consistent with adrenal nodular hyperplasia (Figures 2-5).
case_images: Cerebral CT scan of the index patient.
case_images: CRIE2020-8848151.006.jpg
case_images: PMC7484682_02_CRIE2020-8848151.006.jpg
case_images: fig6
case_images: DNA extracted from peripheral blood leucocyte and in the adrenal gland revealed the presence in heterozygosity of the pathogenic mutation c.1379T < C in the ARMC5 gene, which encodes the protein variant p(Leu460Pro). Due to this finding, the patient underwent a cerebral CT scan, which showed a meningioma in the posterior left temporal convexity (Figure 6).
case_images: Family tree: 1. Proband, 2. affected daughter, 3. healthy son. Circles: females; squares: males.
case_images: CRIE2020-8848151.007.jpg
case_images: PMC7484682_02_CRIE2020-8848151.007.jpg
case_images: fig7
case_images: They were also tested for hypercortisolism and underwent adrenal and cerebral CT scan (Figure 7).