{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:40:03Z","timestamp":1756323603904,"version":"3.44.0"},"reference-count":25,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,6,21]]},"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:p>A woman in her 60s with chronic fatigue, depressed mood and proximal muscle weakness was referred to our endocrinology department. Physical examination revealed facial plethora, atrophic skin and ankle oedema. Adjuvant blood and urine analyses indicated endogenous ACTH-independent Cushing syndrome. Abdominal imaging showed bilateral macronodular adrenals, measuring 58.9 \u00d7 29.7 mm on the right and 55.6 \u00d7 42.6 mm on the left. Primary bilateral macronodular adrenal hyperplasia was confirmed by pathology after bilateral adrenalectomy. Gradual mental and physical recovery was observed in the months following surgery. Genetic sequencing failed to reveal mutations in the ARMC5 gene.<\/jats:p>\n               <jats:p>Cushing syndrome is a rare entity that should be suspected when typical clinical signs, including skin atrophy with ecchymosis, muscle weakness or coloured stretch marks, are present. Primary bilateral macronodular adrenal hyperplasia is an uncommon cause of endogenous Cushing syndrome. It is a benign condition characterised by adrenal macronodules exceeding 1\u2009cm and hypercorticism.<\/jats:p>","DOI":"10.1136\/bcr-2022-254099","type":"journal-article","created":{"date-parts":[[2023,7,7]],"date-time":"2023-07-07T02:00:16Z","timestamp":1688695216000},"page":"e254099","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["ARMC5-negative primary bilateral macronodular adrenal hyperplasia"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6477-1451","authenticated-orcid":false,"given":"Bastiaan","family":"Sol","sequence":"first","affiliation":[{"name":"Endocrinology, AZ Alma Campus Eeklo, Eeklo, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marilyn","family":"Carprieaux","sequence":"additional","affiliation":[{"name":"Anatomical Pathology, ASZ Campus Aalst, Aalst, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nico","family":"De Leu","sequence":"additional","affiliation":[{"name":"Beta Cell Neogenesis Unit, Vrije Universiteit Brussel, Jette, Belgium"},{"name":"Endocrinology, ASZ Campus Aalst, Aalst, Belgium"},{"name":"Endocrinology-Diabetology, UZ Brussel, Jette, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,7,6]]},"reference":[{"key":"2025082711591308000_16.7.e254099.1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-15-0464"},{"key":"2025082711591308000_16.7.e254099.2","first-page":"103","article-title":"The diagnosis of Cushing\u2019s syndrome: an endocrine society clinical practice guideline","volume":"29","author":"Gilbert","year":"2008","journal-title":"Clin Biochem 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