Cushing's syndrome with hypertensive crisis and mixed adrenal cortical adenoma-pheochromocytoma (Corticomedullary adenoma)

Hypertensive crisis developed unexpectedly during removal of an adrenal tumor in a patient with Cushing's syndrome. Preoperative plasma cortisol levels and urinary excretion of 17-hydroxycorticoids, epinephrine and norepinephrine were elevated. Postoperatively, the patient required only adrenal cortical replacement therapy. Histopathologic examination of the tumor disclosed mixed adrenal cortical and medullary cells. States of combined adrenal cortical and medullary dysfunction and their pathophysiologic mechanisms are discussed.