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59 MDW San Antonio United States

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A 64 year old woman with a history of hypertension, cecal and ileal carcinoma status post right hemicolectomy and ileal resection was evaluated for worsening hot flashes and hypertension, and new diabetes in association with an enlarging adrenal nodule. Physical exam was notable for an elevated blood pressure to 16593 but did not reveal abdominal striae, central obesity, or hirsutism. She was noted to have a 1.3 cm right adrenal nodule on CT abdomenpelvis as early as 2012 that was stable in size on repeat imaging in 2013. On CT in 2018, the adrenal nodule was 1.7 cm in size with 60 Hounsfield units of attenuation and no PET avidity. Laboratory evaluation showed elevated urinary and plasma metanephrines free metanephrines 403pgmL 0-62pgmL, free normetanephrine 482mcgmL 0-145pgmL, her cortisol did not suppress on dexamethasone suppression testing DST cortisol 11.4mcgdL 0-3mcgdL, dexamethasone 226 ngdL, late night salivary cortisol was elevated on two occasions 0.173 mcgdL, 0.097 mcgdL 0-0.090 mcgdL, and adrenocorticotrophic hormone ACTH level was 45.62pgmL 6-50pgmL. What is the diagnosis

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  • Medicine and Medical Research

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