Bilateral adrenocortical adenomas causing adrenocorticotropic hormone-independent Cushing’s syndrome: A case report and review of the literature

Table 3 The results of bilateral adrenal vein sampling

	LAV	RAV	L/R	PV
ACTH (pmol/L)	8.50	8.73	/	9.10
F (nmol/L)	11093.75	5746.61	14.86	693.38
ALD (ng/dL)	13.95	8.90	/	5.0
F/ALD	795	645	1.23	/

An AV-to-PV cortisol gradient greater than 6.5 is consistent with a cortisol-secreting adenoma. In our case, the LAV-to-PV cortisol gradient was 16, and the RAV-to-PV cortisol gradient was 8.2. The “aldosterone-corrected” high-side to low-side AV cortisol gradient was 2.3 or greater, consistent with autonomous cortisol secretion predominantly from one adrenal gland; a gradient of 2.0 or less indicates bilateral cortisol hypersecretion. The ratio of L/R of our patient was 1.23, less than 2.0. All of these pieces of evidence indicated that the hypersecretion of cortisol might originate from both adrenal glands[17]. ACTH: Adrenocorticotropic hormone; F: Cortisol; LAV: Left side adrenal vein; RAV: Right side adrenal vein; L/R: (left side adrenal vein cortisol/ left side aldosterone): (right side adrenal vein cortisol/right side aldosterone); PV: Peripheral vein; ALD: Aldosterone; F/ALD: Cortisol/aldosterone.