Endocrine Abstracts

52 years old was admitted to the hospital following 2 weeks of lower limb pain and abdominal swelling. As part of her investigations, she had CT Pulmonary angiogram and CT AP which showed that she had right adrenal lesion with haemorrhage and necrosis in keeping with adrenal carcinoma and invasion of IVC and extension into the right atrium. MRI showed that she had malignant adrenal lesion of 8.8 X 7.6 cm with extension into the IVC and right atrium. She was referred to the MDT regarding the management options as it required multiple teams to be involved for its management. In the meanwhile, she had PET CT scan which showed the lesion to be hypermetabolic and infiltrative in nature. There was no distant metastasis but had extension into IVC and right atrium. She also had full hormonal workup that included 24-hour urine cortisol, ODST Aldosterone renin ratio, Plasma metanephrines, 17-OHP, DHEAS, Androstenedione, Testosterone and SHBG were negative, essentially meaning that lesion was non secretory. She was planned for combined de-bulking surgery involving Liver, Endocrine, Vascular and Cardiothoracic surgical teams as per recommendation from Adrenal MDT. The complex surgery was performed by doing cardiopulmonary bypass between SVC and CFA. She was in deep hypothermic cardiac arrest for 14 minutes and had atrial thrombectomy and tumour was removed from IVC. She also had excision of right adrenal gland. Hence, all macroscopic tumour was removed from the abdomen, IVC and right atrium. She also had required chest drain for pneumothorax. Post surgery she was started on Mitotane and is under oncology. The histology confirmed a non-secretory adrenocortical carcinoma and Ki-67 to be 15%. This case emphasizes the value of a team-based approach in tackling complicated cases. Moreover, an individualized treatment plan can lead to substantial improvements in quality of life.