Endocrine Abstracts

A 77 year old lady was referred by her GP after she was found to have a 6x5x5 cm diameter solid mass in the right adrenal gland on ultrasound scan. The mass showed significant internal vascularity on colour doppler and the radiologist felt it could be a

phaeochromocytoma. She had a long history of hypertension which her GP had been finding difficult to control over the past 2 years.

Type 2 diabetes was diagnosed 2 years ago and she was well controlled on 2.5 mg of glibenclamide a day. BP was 220/110. She had temporal balding and clitoromegaly but was not hirsute and did not look Cushinghoid. Her family had noticed gradual balding over

4-5 years.

Na 143, K 3.3, urea 6.5, creatinine 82,

24 hr urinary free catecholamines x 4 normal, MIBG scan normal

serum cortisol after overnight dexamethasone (1 mg) 390nmol/l,

urinary free cortisol 79 nmol\/24 hr,

ACTH <10 ng\/l, plasma renin activity and plasma aldosterone normal,

testosterone 13.5 (0.5 to 3.8) nmol/l,

androstenedione 23.2 (4 to 10.2) nmol/l,

DHEAS 31.2 (0.4 to 4.7) micromol/l.

CT of abdomen confirmed a 5cm diameter enhancing right adrenal lesion with well defined margins and no other intra-abdominal abnormality. A right adrenalectomy was performed. There was no evidence of metastasis. The specimen weighed 114g. Mitoses were infrequent ( <3 per 50 high power fields) but there was capsular invasion

and the pathologist felt that the lesion should be regarded as having a potential for metastasis.