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Various Adrenal Appearances of Noniatrogenic Hypercortisolism 非医源性皮质醇增多症之肾上腺不同表现 A variety of tumors and tumor-like appearances of the adrenal gland are associated with Cushing syndrome. 多种肾上腺肿瘤及肿瘤样病变与库欣综合征有关。 Adrenal cortical adenoma (a) or adrenal cortical carcinoma (b) may lead to adrenocorticotropic hormone (ACTH)–independent hypersecretion of cortisol. 肾上腺皮质腺瘤（图a）或肾上腺皮质癌（图b）可导致皮质醇促肾上腺皮质激素（ACTH）的自主过度分泌。 下图：左肾上腺皮质腺瘤（同相位及反相位：反相位示病灶信号广泛性减低，提示其内含脂质） 下图：皮质癌。肿瘤体积巨大，密度不均，肾脏受压下移。 Rarer causes of hypercortisolism include macronodular hyperplasia with marked adrenal enlargement (also known as adrenocorticotropin-independent macronodular adrenal hyperplasia) (c) and primary pigmented nodular adrenocortical disease (not shown). 皮质醇增多症的罕见病因包括伴肾上腺明显增大的粗结节状增生(MHMAE)（图c），以及原发性色素性结节状肾上腺皮质病（未显示）。 下图：MHMAE，双侧肾上腺多发大结节样增粗，结节密度较均匀。 Diffuse adrenal cortical hyperplasia (d) may also be observed in Cushing disease (a pituitary-dependent cause of Cushing syndrome secondary to a pituitary adenoma) or rare ectopic tumors secreting ACTH or corticotropinreleasing factor. In the early stages of Cushing disease, the adrenal cortical changes may be subtle. 弥漫性肾上腺皮质增生（图d）也可见于库欣病（继发于垂体腺瘤的垂体依赖性库欣综合征）或罕见的分泌ACTH或促肾上腺皮质激素释放因子（CRF）的异位肿瘤。在库欣病早期，肾上腺皮质改变可能比较轻微。 下图：双侧肾上腺弥漫性均匀增粗，密度较均匀。 Clinical features of hypercortisolism may include increased central weight gain (face, neck, and trunk), fat deposition along the upper back and neck, hirsutism, and facial acne, as shown in the artist’s rendering. 皮质醇增多症的临床表现包括：向心性肥胖（脸、颈、躯干），背部偏上及颈部脂肪堆积，多毛症，面部痤疮（如上图所描绘）。 下图：女，45岁，右侧肾上腺皮质癌
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