Endocrine Abstracts

JOINT2589

Case report: We present a case report supplemented with imaging, laboratory, and histopathological diagnostic documentation, and a review of the literature. A 50-year-old man was admitted to the Department of Endocrinology with a suspected pheochromocytoma.

History: The patient had a previously diagnosed left adrenal tumor, 4 cm in diameter, described on high-density CT. Prior to admission, he had been in the Department of Surgery for abdominal pain suggestive of renal colic accompanied by symptoms of a hypertensive crisis. An abdominal CT scan was performed, which showed a left adrenal lesion with dimensions of 5×4.5×6 cm and a density of 50 H.U. There was no evidence of hyperintense blood signal. In laboratory tests, myocardial necrosis markers and inflammatory parameters were elevated. Blood pressure was found to be elevated, ranging from 200/150 to 150/180 mmHg. Hypotensive medication was administered, and improvement was achieved after 8 days. Due to the suspicion of pheochromocytoma, a 24-hour urine collection for methoxycatecholamines was performed, which showed significantly elevated levels. Based on the ESE/ENSAT 2023 algorithm, the Multidisciplinary Team qualified the patient for excision due to a lesion diameter > 4 cm and high density on CT. Subsequently, repeat diagnostic tests were performed, and methoxycatecholamine levels in both blood and the 24-hour urine collection were within normal limits. In order to prepare the patient for surgery, treatment was modified to include an alpha-blocker. Laparoscopic resection of the periadrenal lesion was performed. Histopathological examination revealed a 3.5 cm tumor – 99% of the tumor was necrotic - surrounded by a fibrous capsule, and a fragment of normal adrenal gland with cells of the three-layered cortex was also visible.

Conclusion: The patient most likely experienced infarction or bleeding into the adrenal tumor, with abdominal pain interpreted as a symptom of renal colic. Symptoms such as hypertension, elevated myocardial necrosis markers, and increased inflammatory parameters may indicate ongoing necrosis. Literature and cases of tumor necrosis were also reviewed. There are cases of tumors such as fibroadenoma of the breast, myoma of the uterus, Warthin’s tumor of the salivary gland, and even lymphoma that undergo “self-destruction” via a necrosis mechanism.