A Rare Case of Cushing’s Syndrome Due to Bilateral Adrenocortical Adenoma

A bstract Cushing’s syndrome due to bilateral cortisol-producing adenoma is extremely rare and may present without the typical Cushingoid appearance, leading to diagnostic uncertainty. This case report involves a 64-year-old woman who presented with resistant hypertension, proximal limb weakness, thin skin with multiple bruises, and a history of hypokalemia, despite the absence of typical striae and centripetal obesity. Normal renin and aldosterone levels excluded primary aldosteronism. After establishing hypercortisolism, a suppressed adrenocorticotropic hormone level indicated an adrenal cause. Computed tomography adrenal protocol revealed large bilateral adrenal masses. After optimization of blood pressure and correction of hypokalemia, laparoscopic bilateral adrenalectomy was done. Histopathology confirmed bilateral adrenocortical adenomas. Hydrocortisone replacement was started postoperatively. At follow-up, her blood pressure became well controlled with fewer medications, electrolytes normalized, and insulin requirement reduced.