Endocrine Abstracts

JOINT3962

Introduction: The discovery of a suspicious pulmonary nodule with adrenal metastasis is a frequent occurrence in the context of a work-up for pulmonary neoplasia. Pathological evidence is usually provided by biopsy of the primary mass. Biopsy of the secondary lesion, particularly the adrenal lesion, is also a second alternative in the event of failure or inaccessibility of the primary lung tumour. We report the case of a patient whose biopsy of the adrenal mass revealed a pheochromocytoma without any complications.

Observation: The patient was 63 years old and smoked 20 packs a year. He complained of a cough that had been treated as acute bronchitis. Physical examination was unremarkable. There was no biological inflammatory syndrome. A chest X-ray was performed when the clinical symptoms persisted. It revealed a pulmonary nodule projecting from the right pulmonary hemichamber. A chest CT scan was performed to better characterise the nodule. We found a lobulated pulmonary nodule with a 12*6mm long axis. The patient also presented with a left adrenal lesion of 10 mm whose enhancement kinetics were consistent with malignancy and in particular a secondary lesion. A pet-scan showed fixation of the 2 lesions with an SUV of 3 and 2.6 respectively. A CT-guided biopsy of the pulmonary nodule concluded that there was chronic and acute pulmonary inflammation. The decision taken at the multidisciplinary consultation meeting was to biopsy the adrenal mass. Metanephrine assay was not requested. The biopsy was performed without incident. Pathological examination revealed a pheochromocytoma. The patient underwent wedge surgery for his pulmonary nodule and left adrenalectomy.

Conclusion: The originality of our case lies in the fact that this patient, who was not hypertensive, underwent a biopsy of an adrenal mass to obtain anatomopathological proof of his bronchopulmonary cancer, which was carried out without incident. Pathology revealed a pheochromocytoma for which the biopsy should have been contraindicated. It was a non-secreting pheochromocytoma. The lesson to be learnt is that adrenal nodules, regardless of their size or the context of suspected pulmonary neoplasia, even in the absence of known hypertension, should not be manipulated before assessing metanephrine levels.