Denouement and Discussion
CONGENITAL HEMIHYPERTROPHY AND ADRENAL CARCINOMA
CONTRIBUTED BY PEGGY J. COPPLE, MD, UNIVERSITY OF OREGON MEDICAL SCHOOL, PORTLAND, ORE, AND WILLIAM Y. DUNCAN III, MD, COLUMBIA-PRESBYTERIAN MEDICAL CENTER, NEW YORK
On physical examination the patient exhibited the obvious manifestations of Cushing's syndrome with obesity, buffalo hump, hypertension (180/120), plethoric facies, acne, and hirsutism. The abdomen was protuberant with purplish striae present and a large mass palpable in the left flank. Routine blood and electrolyte studies were normal except for a fasting blood sugar of 125 mg/100 cc. An intravenous pyelogram revealed downward and anterior displacement of the left kidney. Exploratory laparotomy disclosed a large, ecchymotic, 125 gm tumor of the left adrenal gland. The tumor appeared encapsulated and was totally removed. There was no evidence of metastases. The microscopic diagnosis was that of atypical adrenal cortical carcinoma. Several months postoperatively the cushingoid features were no longer present.