ACTH-independent Cushing's syndrome due to bilateral adrenoc
A 43-year-old female patient presented complaining of fatigue, lower back pain, increased weight, muscle weakness, and amenorrhea. She is a smoker but consumes no alcohol. The patient's history included left hip joint replacement 1 year ago (fracture after trauma) and hypertension for 3 years which was not well-controlled by medication. There is no family history of hypertension but a history of diabetes mellitus was found. She also mentioned a history of irregular steroid use.
Her vital signs at admission were as follows: blood pressure 150/90 mm Hg, heart rate = 77 beats per minute, body temperature = 36.5°C, respiratory rate = 20 breathes per minute, oxygen saturati on room air. On physical examination, we found ecchymosis, thinning of the skin, purple striae, buffalo hump, lower limbs edema, and proximal muscle weakness with no evidence of acne or hirsutism.

Magnetic resonance imaging (MRI) of pituitary gland revealed evidence of a partial empty sella turcica, however, Multi-slice Computed Tomography (MSCT) of the abdomen showed bilateral, heterogeneous, well-demarcated adrenal masses with moderate contrast enhancement with no evidence of hemorrhage or calcification. She was administered with oral prednisolone 10 mg BID (5 mg at morning + 5 mg at night), 0.2 mg of fludrocortisone, 1000 mg of metformin and supplemental calcium with vitamin D3. Clinical and laboratory follow-up showed improvement of her fatigue, blood pressure 110/80, muscle strength, and fasting blood glucose (80 mg/dL).