Endocrine Abstracts (2017) 49 EP54 | DOI: 10.1530/endoabs.49.EP54

Giant adrenal tumor in a patient admitted for fever

João Sérgio Neves1,2, Luís Teles7, Pedro Souteiro1,3, Sofia Castro Oliveira1,3, Ana Isabel Oliveira1,3, Ana Catarina Fernandes4, Margarida Damasceno4, Luísa Graça6, Elisabete Rodrigues1,3, Celestino Neves1,3, Paula Freitas1,5 & Davide Carvalho1,5

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 Medical Oncology, São João Hospital Center, Porto, Portugal; 5Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal; 6Department of Infectious Diseases, São João Hospital Center, Porto, Portugal; 7Serviço de Medicina Interna. Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal.

Introduction: Adrenal tumors are usually detected due to clinical manifestations of hormonal hypersecretion or incidental findings on imaging evaluation. Although most incidentalomas are non-functioning adenomas, it is important to appropriately evaluate such masses to exclude hormonal excess or malignancy.

Case description: An 81-year old male was admitted to our hospital for fever with 15 days of evolution. The patient also presented chills and loss of 3 kg in the last 4 weeks. Regarding past medical history, the patient had type 2 diabetes, hypertension, coronary artery disease, heart failure, cerebrovascular disease (stroke 8 years before), vertebral fractures (3 years before), deep vein thrombosis (3 months before), renal lithiasis and a right adrenal mass (3 cm in the abdominal tomography 16 months before; no functional study available). An elevated C-reactive protein (142 mg/l) was observed, with negative blood and urinary cultures and no other signs of infection. The abdominal ultrasound shown a right adrenal mass of 13 cm. On magnetic resonance, the mass was heterogenous with invasion of inferior vena cava. The patient had no stigmas of Cushing’s syndrome. Plasma catecholamines, urinary catecholamines and metanephrines, and renin and aldosterone levels were normal. The midnight salivary cortisol was normal and the plasma cortisol level after 1 mg overnight dexamethasone suppression test was 3.7 μg/dl. Given the risk for a surgical approach, the fast growth of the tumor and the imaging characteristics suggestive of adrenal carcinoma, a decision to preclude biopsy was made. The patient started mitotane and two months later the mass has 15 cm and the patient is still on follow-up in outpatient setting.

Conclusions: The authors present a case of adrenal carcinoma in a patient with previous adrenal mass not completely studied at presentation. Adrenal incidentalomas are frequent. This case highlights the importance of prompt evaluation of adrenal incidentalomas to early recognize rapidly growing adrenal carcinomas.