ECE2017 Eposter Presentations: Adrenal and Neuroendocrine Tumours Adrenal cortex (to include Cushing's) (86 abstracts)
Adrenal cushing’s syndrome surprisingly unveiling breast cancer
João Sérgio Neves 1, , Ana Isabel Oliveira 1 , Pedro Souteiro 1, , Sofia Castro Oliveira 1, , Helena Baldaia 4 , Daniel Melo 4 , Celestino Neves 1, , Paula Freitas 1, & Davide Carvalho 1,
1Department of Endocrinology, Diabetes and Metabolism, São João Hospital Center, Porto, Portugal; 2Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; 3Faculty of Medicine University of Porto, Porto, Portugal; 4Department of Pathology, São João Hospital Center, Porto, Portugal; 5Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal.
Introduction: Cushing’s syndrome is an endocrinopathy characterized by glucocorticoids excess. Adrenalectomy is the recommend treatment for unilateral adrenal Cushing’s syndrome and is usually associated with resolution of the disease.
Clinical Case: A 54-year old woman with central obesity (BMI 34.3 kg/m2), diabetes and hypertension had a left adrenal mass of 15 mm and characteristics suggestive of adenoma (Hounsfield unit of <10). On CT reevaluation, five years later, there was evidence of mass growth (28 mm) and the characteristics were suspicious of malignant lesion (Hounsfield unit of 38 and absolute contrast washout of 35%). She was then referred to our department for evaluation. Urinary catecholamines and metanephrines were normal, ACTH level was 4.2 pg/ml and the cortisol following 1 mg overnight dexamethasone suppression test was 11.0 μg/dl. The 24 h urinary-free cortisol, late-night salivary cortisol and two-day low-dose dexamethasone suppression test were consistent with ACTH-independent Cushing’s syndrome. A left adrenalectomy was performed. At pathological evaluation, there was a neoplasm of solid pattern, with vascular invasion and a immunohistochemical pattern suggestive of a breast carcinoma metastasis. Mammography revealed a 15 mm nodule with spiculated contours that on breast biopsy revealed a NST (no special type) breast carcinoma. The patient was submitted to neoadjuvant chemotherapy and surgical tumorectomy. Five months after surgery she was admitted in Endocrine department for adrenal insufficiency. Ten months after the adrenalectomy, the patient presents an adrenal insufficiency (compensated with replacement therapy) and maintains follow-up on endocrinology and multidisciplinary breast cancer appointments.
Conclusion: The authors present a case of Cushing’s syndrome of adrenal origin, with a concomitant metastasis of a breast carcinoma. The find of a metastasis in an adrenal mass, is consistent with a tumor-to-tumor metastasis, a rare finding in adrenal masses that, in this case, allowed the diagnosis of a previously unknown breast cancer.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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