case_images: PMC10547568_01
case_images: Enhanced bilateral adrenal CT: (a) bilateral adrenal masses with a significantly strengthened signal at the center of both the glands at onset; CT scan values on the left and right adrenal glands were 30 HU and 58 HU, respectively. (b) Two low-density nodular shadows located on both adrenals 4 days later. CT scan values on the left and right adrenal glands were 15 HU and 12 HU, respectively. (c) Atrophy of adrenal glands in the third-month follow-up. CT scan values on the left and right adrenal glands were 30 HU and 38 HU, respectively.
case_images: IJE2023-6686168.001.jpg
case_images: PMC10547568_01_IJE2023-6686168.001.jpg
case_images: fig1
case_images: Thereafter, whole abdominal computed tomography (CT) revealed bilateral adrenal masses (see Figure 1(a) for the CT image taken at a local hospital). Moreover, instead of performing puncture surgery of the adrenal masses, repeated enhanced bilateral adrenal CT was performed, which revealed two low-density nodular shadows located on both adrenal glands; the right shadow was 30 x 20 mm and the left shadow was 20 x 15 mm (Figure 1(b)), with mean CT values of 15 and 12 HU, respectively. HU, respectively (Figure 1(c)). However, laboratory tests still revealed decreasing serum cortisol and increasing ACTH levels at both 8 AM and 4 PM (Table 1).