J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Case Report

Volume 17, Number 12, December 2025, pages 733-739

Bilateral Adrenalectomy for Primary Bilateral Macronodular Adrenocortical Hyperplasia With a Novel ARMC5 Mutation Site

Figure 1. CT scans before operation. CT images of the patient before adrenalectomy. (a) Image of plain CT scan. (b) Image of arterial phase of contrast-enhanced CT. (c) Image of venous phase of contrast-enhanced CT. (d) Image of delayed phase of contrast-enhanced CT. The red arrows point to the position corresponding to bilateral adrenal nodules on both sides. CT: computed tomography.

Figure 2. Representative gross and microscopic images of the adrenalectomy specimen. (a, b) Gross images showing a large adrenal nodule with appearance resembling a piece of ginger. (c, d) Corresponding microscopic images (× 10).

**Table 1.** The Main Laboratory and Hormone Expression Profile
Time	Baseline	One week after right adrenalectomy	Six months after right adrenalectomy	One month after left adrenalectomy
ACTH: adrenocorticotropic hormone; HbA1c: glycated hemoglobin.
Serum cortisol 8 am (μg/dL)	27.29	14.4	13.3	0.9
Serum cortisol 4 pm (μg/dL)	29.56
Serum cortisol 0 am (μg/dL)	23.65
Serum ACTH 8 am (pg/mL)	1.25	< 1	< 1.5	6.0
Serum ACTH 4 pm (pg/mL)	< 1
Serum ACTH 0 am (pg/mL)	1.3
Urinary cortisol (µg/24 h)	866	748.8	555.8	29.7
HbA1c (%)	9.1		5.7%	6.1%
Fasting blood glucose (mmol/L)	9.84	6.71	5.72
Serum potassium (mmol/L)	3.05	4.36	3.96

Table 1. The Main Laboratory and Hormone Expression Profile

Time

Baseline

One week after right adrenalectomy

Six months after right adrenalectomy

One month after left adrenalectomy

ACTH: adrenocorticotropic hormone; HbA1c: glycated hemoglobin.

Serum cortisol 8 am (μg/dL)

27.29

14.4

13.3

0.9

Serum cortisol 4 pm (μg/dL)

29.56

Serum cortisol 0 am (μg/dL)

23.65

Serum ACTH 8 am (pg/mL)

1.25

< 1

< 1.5

6.0

Serum ACTH 4 pm (pg/mL)

< 1

Serum ACTH 0 am (pg/mL)

1.3

Urinary cortisol (µg/24 h)

866

748.8

555.8

29.7

HbA1c (%)

9.1

5.7%

6.1%

Fasting blood glucose (mmol/L)

9.84

6.71

5.72

Serum potassium (mmol/L)

3.05

4.36

3.96

**Table 2.** The Results of LD-DST and HD-DST
	LD-DST	HD-DST
ACTH: adrenocorticotropic hormone; LD-DST: low-dose dexamethasone suppression test; HD-DST: high-dose dexamethasone suppression test.
Serum cortisol baseline (µg/dL)	27.29	27.29
Serum ACTH baseline (pg/mL)	1.25	1.25
Urinary cortisol baseline (µg/24 h)	866	866
Serum cortisol day 2 (µg/dL)	29.4	38.84
Serum ACTH day 2 (pg/mL)	< 1.0	< 1.00
Urinary cortisol day 2 (µg/24 h)	3,621.0	3,503.1
Serum cortisol day 3 (µg/dL)	33.67	34.79
Serum ACTH day 3 (pg/mL)	< 1.0	< 1.00
Urinary cortisol day 3 (µg/24 h)	2,731.1	4,623.7

Table 2. The Results of LD-DST and HD-DST

LD-DST

HD-DST

ACTH: adrenocorticotropic hormone; LD-DST: low-dose dexamethasone suppression test; HD-DST: high-dose dexamethasone suppression test.

Serum cortisol baseline (µg/dL)

27.29

Serum ACTH baseline (pg/mL)

1.25

Urinary cortisol baseline (µg/24 h)

866

Serum cortisol day 2 (µg/dL)

29.4

38.84

Serum ACTH day 2 (pg/mL)

< 1.0

< 1.00

Urinary cortisol day 2 (µg/24 h)

3,621.0

3,503.1

Serum cortisol day 3 (µg/dL)

33.67

34.79

Serum ACTH day 3 (pg/mL)

< 1.0

< 1.00

Urinary cortisol day 3 (µg/24 h)

2,731.1

4,623.7

**Table 3.** Biochemical Results of AVS
	Inferior vena cava	Left adrenal	Right adrenal	SI left	SI right	LI L/R ratio	LI R/L ratio
SI = cortisol or aldosterone (right or left adrenal)/cortisol or aldosterone (inferior vena cava); LI = cortisol or aldosterone (one side)/cortisol or aldosterone (another side). L/R: left/right; R/L: right/left; AVS: adrenal venous sampling.
Cortisol (µg/dL)	23.71	104.4	79.45	4.4	3.35	2.65	0.38
Aldosterone (pg/mL)	138.81	576.71	1,163.29	4.15	8.38

Table 3. Biochemical Results of AVS

Inferior vena cava

Left adrenal

Right adrenal

SI left

SI right

LI L/R ratio

LI R/L ratio

SI = cortisol or aldosterone (right or left adrenal)/cortisol or aldosterone (inferior vena cava); LI = cortisol or aldosterone (one side)/cortisol or aldosterone (another side). L/R: left/right; R/L: right/left; AVS: adrenal venous sampling.

Cortisol (µg/dL)

23.71

104.4

79.45

4.4

3.35

2.65

0.38

Aldosterone (pg/mL)

138.81

576.71

1,163.29

4.15

8.38