Concealed

A 42 year old woman presents with oligomenorrhea for 2 years, and 30 kg of weight gain during the same period, even though her diet remained unchanged.

Her medical history is significant for type 2 diabetes, hypertension and dyslipidemia for 3 years; while well controlled initially, these have worsened over the last year. She is currently on Metformin, Gliclazide, Telmisartan, and Rosuvastatin.

Her family history is significant for polycystic ovarian disease in a sister. She only drinks socially and does not smoke.

A full blood count is within normal parameters, as are serum electrolytes, and renal and liver profiles. A thyroid profile and serum FSH, LH, testosterone, and growth hormone levels are also normal.

Select Relevant Investigations
Low-Dose DST

Performed

Post dexamethasone serum cortisol level: 170 nmol/L (< 50)
The test is repeated; the new value is 155 nmol/L
24-Hour Urinary Free Cortisol

Performed

24-hour urinary free cortisol: 210 nmol/24h (55-250)
A repeat test is performed; the new value is 180 nmol/24h
Early morning ACTH

Performed

ACTH level: 4 pg/mL (9-52)
MRI Chest + Abdomen

Performed

The MRI scan reveals a homogeneous hypodense mass measuring 5.1 × 3.7 cm in the superior aspect of the left adrenal gland. No other abnormalities are detected.

Select Relevant Management
Laparoscopic Adrenalectomy
Somatostatin Analogues
Stop Metformin
Sibutramine