{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T20:05:19Z","timestamp":1767211519922,"version":"3.41.2"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T00:00:00Z","timestamp":1658707200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>In a small number of cases, the development of ectopic residual adrenal lesions during embryogenesis causing Cushing\u2019s syndrome due to the production of excess cortisol has been reported. A 29-year-old woman was admitted to our hospital for fatigue and recent amenorrhea. Her plasma ACTH was &amp;lt;1.5 pg\/mL, and her serum cortisol was 21.4 pg\/mL after the 8 mg dexamethasone suppression test, revealing the presence of ACTH-independent Cushing\u2019s syndrome; however, her bilateral adrenal glands were atrophied. Abdominal CT revealed a 40-mm round tumor on the right renal hilum and remarkably accumulated <jats:sup>131<\/jats:sup>I-labelled adosterol. CT and bone scintigraphy showed that <jats:sup>99m<\/jats:sup>Tc-methylene diphosphonate had accumulated in her dissymmetric skull at the right-frontoparietal region. The tumor on the right renal hilum was laparoscopically removed. Her cortisol levels rapidly decreased to below the normal range, and glucocorticoids were administered to rescue adrenal insufficiency. The resected tumor was yellowish in appearance and 4.5\u00d73.0\u00d72.8 cm in size. Immunohistochemical staining for SF-1, P450scc, CYP17A, CYP21A, and CYP11B1 indicated that this tumor produced cortisol. Exome sequencing analysis revealed that the <jats:italic>GNAS<\/jats:italic> heterozygous mutation (c.601C&amp;gt;T, p. Arg201Cys; accession number, NM_000516.5) was found in approximately 20% of the adrenal tumor sample. A mutation of <jats:italic>GNAS<\/jats:italic>, encoding the Gs\u03b1 subunit that mediates GPCR signaling, causes the constitutive activation of adenylyl cyclase, resulting in hypersecretion of hormones regulated by the GPCR. <jats:italic>GNAS<\/jats:italic> mutation is one of the major genetic causes of cortisol-producing adrenal tumors independent of ACTH secretion. Considering the combination of <jats:italic>GNAS<\/jats:italic> mutation with one of the typical clinical triad characteristics, fibrous dysplasia of bone, we diagnosed this patient with McCune\u2013Albright syndrome accompanied by ACTH-independent Cushing\u2019s syndrome caused by an ectopic residual adrenal tumor due to <jats:italic>GNAS<\/jats:italic> mutation. This case highlights that <jats:italic>GNAS<\/jats:italic> involves a previously unknown pathological mechanism in which inhibition of the natural elimination of remnant tissue leads to ectopic endocrine hypersecretion.<\/jats:p>","DOI":"10.3389\/fendo.2022.934748","type":"journal-article","created":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T05:25:56Z","timestamp":1658726756000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["ACTH-independent Cushing\u2019s syndrome due to ectopic endocrinologically functional adrenal tissue caused by a GNAS heterozygous mutation: a rare case of McCune\u2013Albright syndrome accompanied by central amenorrhea and hypothyroidism: a case report and literature 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