Giant Adrenal Adenoma Presenting as Cushing Syndrome

We present a case of a 37-years-old male with progressive facial flushing, hair growth in dorsal and lumbar back, easy bruising and diminished libido. The laboratorial workup revealed an adrenocorticotropic hormone-independent Cushing syndrome and elevated levels of testosterone, dehydroepiandrosterone sulfate and androstenedione. Computed tomography scan demonstrated a 10 cm, regular and well-defined lesion in the right adrenal with a heterogeneous pattern of density. The patient was submitted to a right adrenalectomy and the histological exam described a benign lesion without any Weiss criteria. This case represented a clinical challenge due to the overlapping of biochemical and imaging characteristics that prevented a final pre-surgical diagnosis. As histologic criteria can be misleading, long-term follow-up is advisable. So far, the patient is asymptomatic without clinical evidence of hypercortisolism and/or hyperandrogenism.