Primary Pigmented Nodular Adrenocortical Disease with Synaptophysin Immunoreactivity in Two Thai Children(cid:31)
Narumon Patarakijvanich MD*, Kanita Kayasut MD**, Winyou Mitarnun MD**, Sakda Pathrapinyokul MD***, Surasak Sangkhathat Na Ayudya MD***
Affiliation : (cid:31) This paper was originally an oral presentation at The Second Biennial Scientific Meeting of the Asia Pacific Pediatric Endocrine Society, 11-13 November 2002, Cairns, Australia * Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla ** Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla *** Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla
This paper reports the cases of two Thai children diagnosed with primary pigmented nodular adreno- cortical disease (PPNAD). The first was a thirteen and a half year old male who presented with Cushing syndrome for three years and severe osteoporosis. He had hypercortisolemia, a non-suppressible dexametha- sone suppression test, and low serum ACTH. A CT scan showed slight enlargement of both adrenal glands. A bilateral adrenalectomy was performed. The second case was a thirteen-year old female who presented with mild Cushing syndrome for one year with paradoxical response to high-dose dexamethasone suppression test. An MRI revealed suspected microadenoma of the left adrenal gland. Blood sampling showed a higher cortisol level from the left adrenal vein than from the right. A left adrenalectomy was performed, followed by a right adrenalectomy four months later. The pathologies were compatible with PPNAD. Immunostaining for synaptophysin was done in both patients. The cells in the adrenocortical micronodules of both cases were stained intensely with antiserum for synaptophysin, whereas the surrounding adrenal cortex did not.
Keywords : PPNAD, Cushing syndrome, Thai children, Synaptophysin immunoreactivity
