• Large (0.5 cm or more), bilateral nodules of histologically unremarkable adrenocortical tissue in adrenal cortex or protruding into adjacent adipose tissue
  
• Rare (< 100 cases reported)
  
• Mean age 45-55 years
  
• Laboratory: elevated plasma cortisol not suppressed by dexamethasone, low serum ACTH
  

• Bilateral adrenalectomy, does not appear to recur
  

• Enlarged adrenal glands, up to 200 g
  
• May be “massive”
  
• Nodules from 0.2 to 4.0 cm, yellow-tan and not encapsulated
  

• Nodules composed of clear and compact cells with variable lipid
  
• Variable myelolipomatous change, osseous metaplasia or atrophic cortex between nodules
  
• No / rare mitotic figures or atypia
  

• ACTH dependent hyperplasia due to pituitary disease/Cushing's disease
  

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