Subclinical Cushing syndrome associated with an empty sella turcica.

The coexistence of adrenocorticotropic hormone (ACTH)independent Cushing syndrome (CS) and an empty sella (ES) is rare (1, 2). A 53-year-old woman presented with an ES (Picture A, B) and a 40×25-mm left adrenal tumor (Picture C). She had no Cushingoid features, hypertension or diabetes. The levels of morning plasma ACTH, cortisol, dehydroepiandrosterone sulfate and urinary free cortisol were 1.8 (reference range, 7.2-63.3) pg/mL, 5.7 (4.0-19.3) μg/dL, <50 (180-2,100) ng/mL and 9.6 (11.2-80.3) μg/day, respectively. Overnight 1and 8-mg dexamethasone suppression tests indicated unsuppressed morning cortisol levels (3.2 and 2.8 μg/dL, respectively). I-adosterol scintigraphy revealed a strong left adrenal uptake (Picture D). These findings suggested subclinical CS (SCS).