Adrenal histoplasmosis in Cushing's syndrome with bilateral adrenocortical nodular hyperplasia.

In Cushing's syndrome due to adrenal hyperfunction associated with adrenal nodular hyperplasia, two distinct subtypes are recognised. 1 The commoner of the two, Le. macroscopic and nodular hyperplasia, is suggested to represent a process of transition from pituitary dependence to adrenal autonomy.2-4 Compared to classic Cushing's disease, the patients have a longer history, are more resistant to dexamethasone suppression, and have lower corticotropin levels. Pigmented multinodular adrenocortical dysplasia, the second subtype, is less common than the macroscopic form. It is often familial, occurs in children and young adults, and is non-corticotropin dependent. 5,6