Malignant Melanoma Following Bilateral Adrenalectomy for Cushing's Syndrome

Abstract

Reported here is a case of a 31- year-old male with Cushing's syndrome accompanied by mild cutaneous melanin pigmentation and benign junctional nevi. The clinical and biochemical abnormalities were completely reversed by bilateral adrenalectomy. Twelve months following operation malignant melanoma developed, involving the mediastinal and supraclavicular lymph nodes, lungs and bones. During the ensuing 14 months until his death from melanoma, the patient demonstrated generalized progressive melanin pigmentation of the skin which eventually assumed a dark chocolate color. A pituitary tumor was not demonstrable. Cutaneous melanin pigmentation associated with high levels of ACTH following adrenalectomy for Cushing's syndrome has been well documented previously. The occurrence of malignant melanoma under similar circumstances has not been reported. The possibility exists that the high levels of ACTH and melanophore-stimulating hormone observed in the post-adrenalectomy state can contribute to the production of malignant melanoma. It is suggested that patients subjected to adrenalectomy for Cushing's syndrome be carefully followed with this possibility in mind.