Journal
HORMONE RESEARCH IN PAEDIATRICS
Volume 74, Issue 3, Pages 223-228Publisher
KARGER
DOI: 10.1159/000295722
Keywords
ACTH hypersecretion; Adrenalectomy; Brown adipose tissue; Congenital adrenal hyperplasia; Ovarian adrenal rest tumors; Testicular adrenal rest tumors
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Objective: Ovarian adrenal rest tumors (OARTs) are rare in contrast to testicular adrenal rest tumors. We report a case of OART in a patient with congenital adrenal hyperplasia who developed Nelson's syndrome after bilateral adrenalectomy. Methods: We describe the clinical, imaging, and laboratory findings of the patient and review the relevant literature regarding OART and the possible interaction between ACTH and brown adipose tissue. Results: An 18-year-old female with congenital adrenal hyperplasia, who had undergone bilateral adrenalectomy at the age of 10 years, presented with severe hyperpigmentation and hirsutism. Rectal ultrasonography showed a mass in the right ovary. F-18-fluorodeoxyglucose PET/CT revealed intense uptake both in this mass and in brown adipose tissue located in typical supradiaphragmatic sites. Laparoscopic removal of the ovarian mass confirmed the diagnosis of OART. A systematic review revealed 9 documented cases of OART. As in our case, all presented with elevated ACTH levels. Conclusions: Common to all documented cases of OART are sustained high ACTH levels that activate the adrenal anlagen tissue in the ovaries. Copyright (C) 2010 S. Karger AG, Basel
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