Preclinical Cushing's syndrome resulting from adrenal black adenoma diagnosed with diabetic ketoacidosis

Toshio Kahara, Chikashi Seto, Akio Uchiyama, Daisuke Usuda, Hiroshi Akahori, Eiji Tajika, Atsuo Miwa, Rika Usuda, Takashi Suzuki, Hironobu Sasano

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


A right adrenal tumor was incidentally discovered on abdominal computed tomography performed on a 53-year-old Japanese man, who had been hospitalized with diabetic ketoacidosis. Normal values were obtained for adrenal hormones in the morning after an overnight fast and urinary cortisol excretion after treatment of diabetic ketoacidosis with insulin. However, overnight dexamethasone administration with 1 mg or 8 mg did not completely suppress serum cortisol levels. There were no remarkable physical findings related to Cushing's syndrome. The patient was diagnosed as having preclinical Cushing's syndrome (PCS). Histological examination of the adrenalectomy specimen demonstrated adrenal black adenoma. Blood glucose levels subsequently improved after adrenalectomy, and the patient never developed adrenal insufficiency after hydrocortisone withdrawal. The patient was treated with diet therapy alone, and maintained good glycemic control. However, the patient still showed a diabetic pattern in an oral glucose tolerance test. It seems that the existence of PCS in addition to the underlying type 2 diabetes mellitus contributed to aggravation of blood glucose levels. Although there are many aspects of the natural course of PCS that have not been thoroughly elucidated, it is necessary to remain aware that a PCS patient with abnormal glucose metabolism may develop diabetic ketoacidosis by environmental agents.

Original languageEnglish
Pages (from-to)543-551
Number of pages9
Journalendocrine journal
Issue number4
Publication statusPublished - 2007
Externally publishedYes


  • Adrenal black adenoma
  • Diabetic ketoacidosis
  • Preclinical Cushing's syndrome
  • Type 2 diabetes

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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