scholarly journals Multiple Challenges: An Unusual Case of an Adrenal Mass With Plurihormonal Secretion of Catecholamines and Cortisol in a Patient With Several Neoplasms

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A144-A144
Author(s):  
Anna Elvira Seelin Arcellana ◽  
Franz Magnaye ◽  
Carmegie Caparida Saliba ◽  
Soriano Capaya ◽  
Jonathan Rivera ◽  
...  
Keyword(s):  
Case Report ◽  
Adrenal Gland ◽  
Adrenal Mass ◽  
Neuroendocrine Differentiation ◽  
Adrenocortical Adenoma ◽  
Mixed Tumor ◽  
Cardiovascular Risks ◽  
Cortical Cells ◽  
Plasma Aldosterone Concentration ◽  
Free Cortisol

Abstract Introduction: Simultaneous hypersecretion of both catecholamines and cortisol in one adrenal tumor is rarely seen because cortical cells, which produce cortisol, and medullary cells, which secrete catecholamines, are derived from different germ layers1. Formidable challenges ensue from a tumor with a complex behavior. We demonstrate here the clinical course and multi-modal management of the case of an adrenocortical adenoma which had neuroendocrine differentiation accounting for the excess of both catecholamine and cortisol hormones in a patient with multiple neoplasms. Clinical Case: An adrenal mass was incidentally discovered in a 61-year old female undergoing imaging as part of the metastatic work-up for an esophageal mass. The patient has insulin-requiring diabetes mellitus, hypertension and a history of breast cancer. A right adrenal gland mass, avidly enhancing, measuring 3.8 x 2.7 x 2.7 cm was found on abdominal imaging. The 24-hour urine metanephrine collections were done, and these were more than twice elevated in two instances at 2.516 mg/24 hours and 2.101 mg/24 hours (NV: 0–1 mg/24 hours). An unsuppressed cortisol level at 6.57 μg/dL (NV: ≤ 1.8 μg/dL) was obtained after the 1 mg dexamethasone suppression test. Hypercortisolism was confirmed with an elevated 24-hour urine free cortisol at 312.07 μg/24 hours (NV: 20–90 μg/24 hours). Adrenocorticotrophic hormone (ACTH) was low at 0.90 pg/ml, indicative of the presence of an adrenal form of Cushing’s. Primary aldosteronism was ruled out based on a ratio between plasma aldosterone concentration and plasma renin activity of less than 20. Pre-operative alpha blockade with terazosin was initiated. Right adrenalectomy was done. Histopathology revealed an adrenal mass of cortical origin, atypically staining positively for synaptophysin, which is indicative of neuroendocrine differentiation of the tumor. The patient had better blood pressure and glycemic control after the adrenalectomy. Clinical Lessons: An adrenocortical adenoma very seldom undergoes neuroendocrine differentiation. Pathophysiologic mechanisms include a genetic aberration in cortical cells leading to production of catecholamines2. This case underscores the importance of a comprehensive biochemical evaluation of a patient with an adrenal mass because control of hormonal hypersecretion is essential in reducing cardiovascular risks, morbidity and mortality. References: 1Duan L, Fang F, Fu W, et al. Corticomedullary mixed tumor resembling a small adrenal gland-involvement of cancer stem cells: case report. BMC Endocr Disord. 2017;17(1):9. Published 2017 Feb 13. doi:10.1186/s12902-017-0157-7.2Donatini G, Van Slycke S, Aubert S, Carnaille B. Corticomedullary mixed tumor of the adrenal gland-a clinical and pathological chameleon: case report and review of literature. Updates Surg. 2013 Jun;65(2):161–4. Epub 2012 Jan 7. PMID: 22228558.

Corticomedullary Mixed Tumor of the Adrenal Gland With Concurrent Adrenal Myelolipoma

2003 ◽  
Vol 127 (8) ◽  
pp. e329-e332 ◽  
Author(s):  
Albert Y. Chu ◽  
Virginia A. LiVolsi ◽  
Douglas L. Fraker ◽  
Paul J. Zhang
Keyword(s):  
Adrenal Gland ◽  
Adrenal Mass ◽  
Cushing Syndrome ◽  
Rare Tumor ◽  
Mixed Tumor ◽  
Left Adrenal Gland ◽  
Urinary Cortisol ◽  
Cortical Cells ◽  
Adrenal Myelolipoma ◽  
Adrenal Cortical Cells

Abstract We report the case of a corticomedullary mixed tumor of the adrenal gland in a 55-year-old woman with a left adrenal mass who presented with mild symptoms of Cushing syndrome and an elevated urinary cortisol level. The patient underwent a left adrenalectomy. A well-circumscribed 2.5-cm mass, composed of an admixture of adrenal cortical cells and pheochromocytes, and an incidental 0.7-cm myelolipoma were present in the resected left adrenal gland. The diagnosis of adrenal corticomedullary mixed tumor was confirmed by both immunohistochemistry and electron microscopy. To our knowledge, this is the eighth well-documented report of this rare tumor.

scholarly journals Virilization in a Girl with Adrenocortical Adenoma: A Case Report

2013 ◽  
Vol 6 (2) ◽  
pp. 70-72
Author(s):  
Tahniyah Haq ◽  
SM Ashrafuzzaman ◽  
Zafar A Latif
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Adrenal Gland ◽  
Ct Scan ◽  
Dehydroepiandrosterone Sulfate ◽  
Adrenocortical Adenoma ◽  
Adrenal Carcinoma ◽  
Mass Size ◽  
The Right ◽  
Androgen Levels

We present a case of Cushing’s syndrome and virilization in a 15 year old girl which was suspected to be due to an adrenal carcinoma. She presented with features of virilization in addition to those of hypercortisilism. Her high androgen levels especially dehydroepiandrosterone sulfate (DHEAS) were also in favor of an adrenal carcinoma. An unenhanced computerized tomography (CT) scan showed a mass (size: 5.3 cm) in the right adrenal gland with a soft tissue intensity of more than 10 HU which was suggestive of adrenal carcinoma. But, histopathology of the resected mass revealed a benign adrenocortical adenoma. DOI: http://dx.doi.org/10.3329/imcj.v6i2.14736 Ibrahim Med. Coll. J. 2012; 6(2): 70-72

scholarly journals SUN-154 Resistant Hypertension After Shockwave Lithotripsy: The Rude Awakening of an Adrenal Incidentaloma

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Ramon B Larrazabal
Keyword(s):  
Blood Pressure ◽  
Adrenal Mass ◽  
Adrenal Incidentaloma ◽  
Adrenal Tumors ◽  
Shockwave Lithotripsy ◽  
Adrenocortical Adenoma ◽  
Institutional Perspective ◽  
Surgical Interventions ◽  
First Case ◽  
Free Cortisol

Abstract BACKGROUND The National Institutes of Health defines adrenal incidentalomas (AIs) as clinically inapparent adrenal masses discovered inadvertently in diagnostic testing or treatment for conditions not related to the adrenal glands. Non-functional adenoma remains the most frequent (60–85%) cause, while functional adenomas at 5–16%. CLINICAL CASE A previously healthy 41 year-old female consulted for a 2-month history of left flank pain. Computed tomography (CT) scan of the kidneys revealed left calculi and incidental right adrenal mass. She was asymptomatic at this time. She then underwent shockwave lithotripsy for the renal calculi. However, post-operatively, she had elevated blood pressure and was started on anti-hypertensives. She remained hypertensive despite being on four different medications. Pertinent physical examination findings: plethora of the face and extremities, Moon facies, Buffalo Hump, and pendulous abdomen with grayish striae. Further work-up revealed the AI to be cortisol-secreting. Pertinent laboratories: 1 mg dexamethasone suppression test - 800 nmol/L (<50 nmol/L), 24-hr urine free cortisol - 1014.86 ug/24 hr (20–90 ug/24 hr), Adrenocorticotropic Hormone (ACTH) - 5.0 pg/ml (9–52 pg/ml). She then underwent a right laparoscopic adrenalectomy. Post-operatively, her blood pressure normalized without her anti-hypertensive medications. Tissue biopsy of the mass was consistent with an adrenocortical adenoma. On her follow-up after one month, signs of Cushing’s Syndrome were clinically improving. CONCLUSION This is the first case that demonstrated shockwave lithotripsy converting a non-functioning adrenal incidentaloma into a functioning one. It also shows how internists and surgeons (i.e. Urologists) can manage various aspects of patient care through the facilitation of medical treatments, surgical interventions, and ensuring a proper multidisciplinary approach based on the endocrinology clinical guidelines. So as not to delay the delivery of proper management to the patient. REFERENCES (1) Grumbach M, Biller B, Braunstein G. et al. “Management of the clinically inapparent adrenal mass (“incidentaloma”).” Annals of internal medicine 2003; 138:424–4292 Herrera M, Grant C, van Heerden J. et al. “Incidentally discovered adrenal tumors: an institutional perspective.” Surgery 1991; 110:1014.

scholarly journals Primary adrenal sarcomatoid carcinoma

2014 ◽  
Vol 4 (1) ◽  
Author(s):  
Aftab S. Shaikh ◽  
Girish D. Bakhshi ◽  
Arshad S. Khan ◽  
Nilofar M. Jamadar ◽  
Aravind Kotresh Nirmala ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Adrenal Gland ◽  
Adrenal Mass ◽  
Sarcomatoid Carcinoma ◽  
Review Of Literature ◽  
Rare Tumors ◽  
Radiological Evidence ◽  
The Right

Adrenal sarcomatoid carcinomas are extremely rare tumors presenting with extensive locoregional spread at the time of diagnosis. Patients succumb to metastases within a couple of months. As a result, very few cases are reported in the literature until now. We present a case of a 62-year old female with non-functional sarcomatoid carcinoma of the right adrenal gland. There was no radiological evidence of locoregional metastases. Patient underwent right adrenalectomy. Follow up after 3 months showed para-aortic lymphadenopathy and similar left adrenal mass on computed tomography. Patient refused further treatment and succumbed to the disease. A brief case report with review of literature is presented.

scholarly journals Extramedullary hematopoiesis in the adrenal: Case report and review of literature

2013 ◽  
Vol 7 (5-6) ◽  
pp. 436 ◽  
Author(s):  
John S. Banerji ◽  
Kumar Manoj Ramani ◽  
A. Devasia
Keyword(s):  
Case Report ◽  
Adrenal Gland ◽  
Lymph Nodes ◽  
Laparoscopic Adrenalectomy ◽  
Adrenal Mass ◽  
Extramedullary Hematopoiesis ◽  
Asymptomatic Individual ◽  
Review Of Literature ◽  
Extramedullary Haematopoiesis ◽  
History Of

Extramedullary haematopoiesis (EMH) is common in the spleen, liver and lymph nodes, or in para osseus sites. EMH in the adrenal is rare, with fewer than 10 cases reported. We report the case of a 40-year-old male who underwent laparoscopic adrenalectomy for an incidentally detected adrenal mass. The histology showed extramedullary hematopoesis. In patients with a known history of haemolytic anaemia, an enlarged adrenal gland in an asymptomatic individual could represent extramedullary haematopoesis. A confirmatory biopsy would be all that is necessary to avoid adrenalectomy.

Primary Adrenal Glomus Tumor: The First Case Report

2021 ◽  
pp. 1-4
Author(s):  
Yuqi Hu ◽  
Xianglei He ◽  
Qi Zhang ◽  
Dahong Zhang ◽  
Ming Zhao
Keyword(s):  
Case Report ◽  
Adrenal Gland ◽  
Adrenal Mass ◽  
Glomus Tumor ◽  
Left Adrenal Gland ◽  
Unique Case ◽  
Primary Tumors ◽  
First Case ◽  
Tomography Scan

We report a unique case of a 25-year-old man who was incidentally identified to have a mass in the left adrenal gland region by computerized tomography scan. The image revealed a 1.8 × 1.6 cm, well-defined adrenal mass with moderately homogeneous enhancement. The mass was laparoscopically completely removed, and the diagnosis of a solid variant glomus tumor of the adrenal gland was rendered. There were no histologic features indicating atypia or malignance and no primary tumors anywhere else. The patient was free of disease at the 6-month follow-up. To our knowledge, this is the first case of primary adrenal glomus tumor described in the literature.

scholarly journals A Unique Case of Corticomedullary Mixed Tumor Composed of Both Adrenal Cortical Cells and Pheochromocytes

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A106-A107
Author(s):  
Srinivas R Panja ◽  
Safrin Ali
Keyword(s):  
Adrenal Gland ◽  
Adrenal Adenoma ◽  
Pathology Report ◽  
Mixed Tumor ◽  
Unique Case ◽  
Cortical Cells ◽  
Post Surgery ◽  
Biochemical Testing ◽  
Abstract Submission ◽  
Mixed Tumors

Abstract Introduction or Background: Corticomedullary mixed tumors of the adrenal gland was first described in 1969 by Mathison and Waterhouse. It is defined as a single tumor mass of the adrenal gland that histopathologically has presence of adrenal cortical and medullary cells. Such mixed tumors involving the cortical and medullary components of the adrenal glands are very rare. Clinical Case (including diagnostic evaluation, treatment, and follow-up):A 67 year old woman with a history of hypertension and osteoporosis presents for incidental adrenal adenoma. Hypertension was controlled well with olmesartan 40mg, hctz 25mg, and amlodipine 2.5mg. Abdominal CT scan showed a 2.6 cm enhancing left adrenal nodule with delayed wash- out phase. Biochemical testing showed elevated plasma free metanephrine (132pq/ml, n < or = 57pq/ml) and abnormal 1mg dexamethasone suppression test (10.4mcg/dL, n <2mcg/dL). ACTH was suppressed. Patient underwent left adrenalectomy, after pretreatment with doxazosin. Surgical pathology report showed an unusual neoplasm consisting of a single nodule composed of intermixed aggregates of cortical cells and pheochromocytes displaying morphologic features of adrenal adenoma and pheochromocytoma. Also intermixed with the adenoma was a 3mm myelolipoma. Post surgery, the patient was treated with hydrocortisone for symptoms of adrenal insufficiency. Post surgery, she was able to stop amlodipine and hctz and is on 10 mg olmesartan on alternate days.. She remains on a weaning dose of hydrocortisone at the time of abstract submission. Clinical Lesson(s) or Conclusion(s) (emphasizing the learning point[s] and implications for clinical practice)This unique case report highlights the importance of appropriate workup for incidental adrenal adenoma and keeping in mind the rare possibility of mixed endocrine tumours. A single mixed tumor of the adrenal gland is rare but exhibits distinct morphologic features of both a cortisol producing tumor along with a pheochromocytoma. Furthermore, a concurrent intermixing of a myelolipoma within an adrenal corticomedullary mixed tumor is rarely reported.

scholarly journals Phaeochromocytoma comb?ned with subclinical Cushing's syndrome and pituitary microadenoma

2008 ◽  
Vol 31 (3) ◽  
pp. 176 ◽  
Author(s):  
Guzin Fidan Yaylali ◽  
Fulya Akin ◽  
Mehmet Bastemir ◽  
Yalin Tolga Yaylali ◽  
Akin Ozden
Keyword(s):  
Adrenal Gland ◽  
Cushing’S Syndrome ◽  
Adrenal Mass ◽  
Sella Turcica ◽  
Cushing's Syndrome ◽  
Urinary Catecholamines ◽  
Pituitary Microadenoma ◽  
Free Cortisol ◽  
Cortisol Levels ◽  
The Right

Objectives: Phaeochromocytoma (PHEO) occasionally associates with pathological lesions of the adrenal cortex. The coexistence of PHEO and pre-clinical Cushing's syndrome (PCS) of the same adrenal gland has rarely been reported. We report a case of PHEO and PCS originating from the same adrenal gland and discuss the peculiar diagnostic aspects of this entity. Clinical Presentation: A 64 yr old man was hospitalized to evaluate the right adrenal mass which was discovered incidentally by ultrasonography. He had a history of type 2 diabetes mellitus and hyperlipidemia. Blood pressure measurements were all normal during his hospital stay. Laboratory examination showed: urinary catecholamines were markedly increased. HbA1C of 14.3 %, midnight cortisol of 11(?g/dL), cortisol was not suppressed after the overnight 1 mg oral dexamethasone suppression test (DST): 3.42(?g/dL), 24 hr free cortisol in the urine : 213 µg/day (10-100), cortisol levels were suppressed more than 50% with 8 mg of dexamethasone. CT scan of the adrenal glands showed a 6 cm well encapsulated right adrenal mass together with a clearly normal left adrenal gland. MRI investigation of the sella turcica revealed a pituitary microadenoma on the right side of the adenohypophysis He was treated with ? and subsequent ? blockers after the diagnosis of PHEO and PCS was made. Right adrenalectomy was performed. The pathology showed typical PHEO with adrenocortical hyperplasia. VMA, metanefrin and free cortisol levels were normalized one month after surgery. Conclusion: The present report is a rare case of PHEO combined with PCS in the same adrenal gland.

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