One year six monmonths old female infant was referred to KATH, Kumasi with sudden onset of excessive weight gain over the past 3months. Weight gain associated with voracious appetite
Examination : obviously obese child
Wt 14.1kg,  weight for age 2sd,   BMI 27
RBS 7.4mmol/l
BP 126/80mmhg     Sys 99th *10   Dias 99th *10
Acne vulgaris face and trunk
Hypertrichosis
Increased fat deposition on chest and trunk, face, limb
Breasts are enlarged Tanner stage III -IV
Pubic hair present Tanner II
Clitoris enlarged
Labs done:
Hormonal assay:
Serum cortisol      1796nmol/l
serum Testosterone 8.2 nmol ( .07-.35)
ACTH        44.7 ( less than 46 )
Electrolytes:  Na 135,  K  2.1  ,    Cl  9.4  ,   Ca 1.34  ,   Mg 6.9 Phosphates .35
Abdominal USG:  Poorly defined left suprarenal mass 8.2 *5.4 *6.4 cm
Diagnosis : Adrenal adenoma
Patient was put on lisinopril, Amodipine, Ketoconazole
Potassium and calcium were levels were corrected prior to surgery
Surgery : 20cm left transverse left  upper quadrant abdominal incision used to perform laparotomy
Surgeons : Dr Nimako Boateng
Assistants: Dr Yifieyeh,  Dr Ametih
Supervising Surgeon : Prof Abantanga
Findings : Left suprarenal gland enlarged inferiomedially, attached to large bowel, stomach, medial superior pole of  left kidney
Post operative state : hypokalaemia, respiratory distress. Patient was in ICU for three days and transfered to child health, endocrinology  ward. child later developed wound infection
There was an incidence where the ward cover doctor was called to see the child who had seized breathing. Doctor realised that the infusion containing IV KCl was running too fast and so stopped it. Chld could not be resuscitated and so died .