Adrenal and pituitary incidentalomas in a case of Cushing's syndrome

Cushing's syndrome is a pathological condition where surgery may be lifesaving. The proper diagnosis depends upon the hormonal pattern of the patient, various dynamic tests and imagistic investigations. We report a case of a patient with Cushing's syndrome, with bilateral adrenal tumors and a pituitary microadenoma. She presented increased levels of basal cortisol, unsuppressed during a low and a high dose Dexamethasone test. She underwent right laparoscopic adrenalectomy and developed acute adrenal insufficiency. Two years after the intervention, she still requires adrenal substitution therapy. Acute adrenal crisis is a serious complication of adrenal surgery, with high mortality if unrecognized.