The Korean Journal of Internal Medicine : 23:49-52, 2008 A Case of Cushing’s Syndrome Presenting as Endometrial Hyperplasia Sang Min Lee, M.D.1, Jong Ryeal Hahm, M.D.1, 3, Tae Sik Jung, M.D.1, 3, Jung Hwa Jung, M.D.1, Mi Yeon Kang, M.D.1, Sun Joo Kim, M.D.2, 3 and Soon Il Chung, M.D.1, 3 Departments of Internal Medicine1 and Laboratory Medicine2, Gyeongsang Institute of Health Science3, Gyeongsang National University College of Medicine, Jinju, Korea We describe here the case of a 39-year-old woman with a cortisol-producing adrenal adenoma and she presented with endometrial hyperplasia and hypertension without the specific characteristics of Cushing's syndrome. The patient had consulted a gynecologist for menometrorrhagia 2 years prior to her referral and she was diagnosed with endometrial hyperplasia and hypertension. Her blood pressure and the endometrial lesion were refractory despite taking multiple antihypertensives and repetitive dilation and curettage and progestin treatment. On admission, the clinical examination revealed mild central obesity (a body mass index of 22.9 kg/m2, a waist circumference of 85 cm and a hip circumference of 94cm), but there was no hirsutism and myopathy. She showed impaired glucose tolerance on an oral glucose tolerance test. The biochemical hypercortisolemia together with the prolactin and androgen levels were evaluated to explore the cause of her anovulation. Adrenal Cushing's syndrome was confirmed on the basis of the elevated urinary free cortisol (454 μg/24h, normal range: 20-70) with a suppressed ACTH level (2.0 pg/mL, normal range: 6.0-76.0) and the loss of circadian cortisol secretion. A CT scan revealed a 3.1 cm, hyperechoic, well-marginated mass in the left adrenal gland. Ten months post-adrenalectomy, the patient had unintentionally lost 9 kg of body weight, had regained a regular menstrual cycle and had normal thickness of her endometrium. Key Words : Cushing syndrome; Endometrial hyperplasia; Metabolic syndrome X; Adrenocortical adenoma INTRODUCTION The prevalence of obesity and its related disorders is rapidly increasing with increasing economic development and the growing convenience of modern life, but obesity and weight gain can also be caused by drugs and several endocrine disorders such as Cushing's syndrome. Cases of mild or subclinical Cushing's syndrome are increasingly being reported owing to emerging concerns about health problems and the develop- ments of image technology1). Cushing's syndrome is well characterized by central obesity, proximal muscle weakness, bruising, violet striae, menstrual irregularities and hirsuitism. Obesity, especially central obesity, is also associated with metabolic syndrome, polycystic ovary syndrome (PCOS) and other disorders that present with menstrual irregularities, including endometrial hyperplasia. Clinicians must stay alert for the possibility of secondary causes of menstrual abnormalities in patients with recent weight gain to formulate a correct diagnosis. In this report, we describe the case of a 39-year-old woman with a cortisol-producing adrenal adenoma that presented as refractory endometrial hyperplasia and hypertension, and she was without any of the remarkable, specific characteristics of Cushing's syndrome. ∙Received : January 3, 2007 ∙Accepted : April 18, 2007 ∙Correspondence to : Jong Ryeal Hahm, M.D., Department of Internal Medicine, College of Medicine, Gyeongsang National University, 90 Chilam-dong, Jinju 660-702, Korea Tel : 82-55-750-8851, Fax : 82-55-758-9122, E-mail : jrhahm@medimail.co.kr *This work was supported in part by the foundation for Gyeongsang National University Hospital.