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Methods for distinguishing these lesions include adrenal venous sampling and 131I-6��-iodomethyl-19-norcholesterol (131I-NP-59) scintigraphy. We present a case of a 29-year-old Han Chinese female patient with a history of hypercholesterolaemia and polycystic ovary syndrome. She presented with a 6month history of an 8kg body weight gain and gradual rounding of the face. Serial examinations revealed loss of circadian rhythm of cortisol, elevated urinary free-cortisol level and undetectable ACTH selleck chemicals level (VAV2 syndrome presenting with bilateral adrenal masses. Learning points The clinical presentation of Cushing�� syndrome includes symptoms and signs of fat redistribution and protein-wasting features. The diagnosis of patients with ACTH-independent Cushing��s syndrome with bilateral adrenal masses is challenging for localisation of the lesion. Both adrenal venous sampling and 131I-NP-59 scintigraphy are good methods to use in these patients with Cushing��s syndrome presenting with bilateral adrenal masses. Background Lonafarnib Cushing��s syndrome results from prolonged, inappropriate exposure to excessive amounts of circulating free cortisol. Endogenous Cushing��s syndrome is classified as either corticotrophin (ACTH) dependent or ACTH independent (1). The two most common aetiologies of ACTH-independent Cushing��s syndrome are adrenal adenoma and carcinoma. Adrenal adenomas are responsible for approximately 10�C15% of cases of Cushing��s syndrome, and adrenal carcinomas are responsible for