Stress-associated transient enlargement of pre-existing adrenal hyperplasia in 21-hydroxylase deficiency: a case report

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A 40-year-old man with 21-hydroxylase deficiency exhibited marked bilateral adrenal enlargement following an acute upper respiratory infection.
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Endocrinology markers indicated elevated ACTH and 17α-hydroxyprogesterone levels, confirming a diagnosis of congenital adrenal hyperplasia.
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Without specific treatment, the patient's adrenal volume decreased significantly from 61.06 cm3 to 33.47 cm3 within one month.
4

The transient adrenal enlargement was hypothesized to be a stress-induced compensatory response to increased cortisol demand.
5

The case highlights the potential for infectious stress to trigger temporary changes in adrenal morphology in patients with congenital adrenal hyperplasia.

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