THE COEXISTENCE OF PHEOCHROMOCYTOMA AND ADRENOCORTICAL HYPERPLASIA*

Abstract

A case of hirsutism, acne, polydipsia, polyuria, weight loss and one known episode of hypertension is reported. The patient was a 22-year-old woman. Laboratoiy investigations revealed glycosuria, hyperglycemia, hypermctabolism, and elevated levels of urinary catechol amines, urinary 17-ketosteroids and plasma 17-hydroxycorticoids. Upon x-ray examination, a left suprarenal mass could be seen. At operation a large benign pheochromocytoma was found in the left adrenal and also marked adrenocortical hyperplasia on the left. Nine months after surgery, the hirsutism and acne were improved. Glucose tolerance, the basal metabolic rate, and the results of the histamine test and the adrenocortical function studies were all entirely normal. Since the patient did not require cortisone therapy for a significant period of time postoperatively, and since unilateral adrenalectomy had been curative, it was inferred that the contralateral adrenal cortex at the time of operation was neither atrophic nor affected by the usual type of adrenal hyperplasia. It is postulated that both adrenal cortices were lryperplastic, secondary to some substance or substances,the source of which was removed by unilateral adrenalectomy. The older medical literature suggests that epinephrine stimulates adrenocortical function, but newer adrenocortical function tests indicate no significant effect. Therefore, there is no good evidence that the co-existence of pheochromocytoma and adrenocortical hyperplasia in this patient was other than coincidental.