Clinical communication to the Editor

Bilateral Adrenal Adenomas and Persistent Leukocytosis: A Unique Case of Cushing’s Syndrome

Case report

A 30-year-old white woman presented to her primary care physician in August 2003 for fatigue of 1 month’s duration. She had an elevated white blood cell count (14.4 × 10⁹/L) and was found to have urinary tract infection and an ear infection for which she was treated with antibiotics. Since leukocytosis persisted even after treatment, she was referred to the hematology service in September 2003. Her past medical history was significant for polycystic ovary syndrome, frequent vaginal yeast

Discussion

This case is unique, as the patient presented only with persistent leukocytosis (with normal differential count). She initially denied common symptoms of Cushing’s syndrome except chronic fatigue and frequent infection. She had no stigmata of Cushing’s syndrome on initial clinical examination. She developed classic features of Cushing’s syndrome later on during her evaluation for bilateral adrenal masses.

Bilateral functioning adrenal adenomas are very rare. Only 25 cases have been reported

Acknowledgment

We would like to thank Dr. Harold Carlson for reviewing the manuscript.