Can Extra-Adrenal Cortisol Secretion Occur in an Adrenalectomized Patient?

The document reports a case of a 38-year-old female who, despite undergoing bilateral adrenalectomy and being on hydrocortisone replacement, exhibited signs of endogenous cortisol secretion, such as weight gain and increased body hair, without experiencing ill effects from occasionally missing her medication. Her cortisol levels were elevated, and she was able to suppress cortisol normally after a Dexamethasone suppression test, with no adrenal tissue found on CT scans. The patient eventually weaned herself off hydrocortisone. The discussion suggests that this cortisol secretion could be due to residual adrenal tissue or extra-adrenal sources of steroid synthesis, such as the skin, gonads, and thymus, although these sources typically do not produce sufficient levels for a significant stress response. The document also references evidence of adrenal regeneration in animals and a case of adrenal regeneration in a human after adrenalectomy, suggesting a possible explanation for the patient's condition.