Thought to have 'gained weight' after marriage, turned out to be adrenal gland tumor

Ho Chi Minh City Ms. Dung, 26 years old, gained 10 kg in three months, thought she had "got fat" after getting married, the doctor diagnosed an adrenal tumor causing Cushing's syndrome.

In addition to gaining weight, Ms. Dung's belly accumulated fat, her legs atrophied and made it difficult to walk, she lost hair, had hair growth on her back, thin skin and bruised easily, and her face turned red as if she had an allergy. Thinking she would "get fat" after getting married, she tried many ways to lose weight such as fasting, using weight loss foods... After two months, she lost two kilos but felt tired and exhausted so she stopped using them.

She went to many hospitals in Ho Chi Minh City for examination and was diagnosed with Cushing's syndrome (an endocrine disease) due to taking drugs containing corticosteroids. She took Western medicine for two months, switched to Chinese medicine and Vietnamese medicine but it did not help, so she went to Tam Anh General Hospital in Ho Chi Minh City for examination.

On November 10, Dr. Tran Thuy Ngan, Department of Endocrinology - Diabetes, said that the patient's symptoms were due to Cushing's syndrome. This is an endocrine disease caused by prolonged increase in cortisol in the blood or long-term use of substances containing corticosteroids (with effects similar to cortisol). However, the patient did not respond to treatment for Cushing's syndrome due to drugs containing corticosteroids. The doctor predicted that the endogenous cause was caused by the pituitary gland or adrenal gland.

ACTH (adrenal stimulating hormone that produces cortisol) test results showed normal indicators, excluding the cause of increased ACTH secretion.

The doctor performed an abdominal ultrasound on the patient and found a tumor on the kidney. A CT scan later confirmed a tumor in the right adrenal gland, about 4 cm in size. This is the cause of increased secretion of the hormone cortisol (secreted from the adrenal gland), causing Cushing's syndrome.

The patient's face has fat accumulation. Photo: Dinh Tien

Patients are treated with adrenal hormone adjustment, electrolytes, blood pressure regulation, and health assessment before tumor removal surgery.

MSc. Dr. Nguyen Tan Cuong, Deputy Head of the Department of Urology, Urology and Andrology Center, said that the patient's adrenal tumor was large, with many blood vessels proliferating, surrounded by organs such as the liver, kidneys, spleen and large blood vessels... If there was a small mistake during surgery, bleeding or damage to nearby organs could occur. Adrenal tumors secrete a lot of the hormone cortisol, causing sudden, difficult-to-control increase in blood pressure, which can lead to the risk of arrhythmia and stroke during surgery.

The Anesthesiologist places a catheter in the patient's wrist to monitor arterial blood pressure and a jugular venous catheter to measure blood flow to control blood pressure. This allows the doctor to quickly respond to high blood pressure or blood loss.

Doctor Tan Cuong (right) and MD Phan Huynh Tien Dat (left) perform surgery to remove an adrenal tumor from a patient. Photo: Dinh Tien

Dr. Cuong and his colleagues performed retroperitoneal laparoscopic surgery to remove an adrenal tumor through three small incisions in the lower back. An ultrasonic scalpel helped the doctor dissect the tissue around the adrenal gland, cut the tissue, and stop bleeding immediately. The tumor was removed, the patient lost little blood, and the right adrenal gland was preserved to reduce the risk of adrenal insufficiency after surgery.

Ms. Dung recovered well, her electrolytes, blood cortisol and blood pressure were stable, her face was no longer red and she was no longer tired. The function of her two adrenal glands was stable, and she was discharged after two days.

According to Dr. Ngan, Cushing's syndrome occurs mainly in women aged 25-40. The disease is caused by two factors: exogenous and endogenous. Exogenous causes are due to drugs, long-term use of corticosteroids to treat autoimmune diseases, arthritis, lupus, asthma... or long-term abuse of drugs without a doctor's prescription. Endogenous causes are often due to increased ACTH secretion by the pituitary gland or tumors in the adrenal glands...

Long-term progression of the disease causes complications such as obesity, high blood pressure, diabetes, osteoporosis, vertebral collapse, bone fractures, mental disorders, skin pigmentation, kidney stones...

Doctors recommend that people should not arbitrarily use drugs containing corticosteroids such as pain relievers, bone and joint treatment, sinusitis to prevent Cushing's syndrome caused by corticosteroids. Regular health check-ups at least once a year help detect the disease early.

People who show signs of unexplained weight gain, fat face, belly, shoulders; atrophied limbs, red cheeks, thin skin, easy bruising, wounds that are difficult to heal, stretch marks, thick beard and hair growth... should see an Endocrinologist - Diabetic for examination.

Dinh Tien

* Patient name has been changed

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