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 Cushings 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.
20 - 23 May 2017
European Society of Endocrinology