Session: MON 1-36-Adrenal Incidentaloma & Carcinoma
Poster Board MON-28
Our patient is a 50-year-old post-menopausal woman with hypertension, dyslipidemia who was admitted to hospital for exertional dyspnea, likely due to restrictive cardiomyopathy thought to be caused by her SA (light chain type). Endocrine consult was done as her abdominal CT revealed a left adrenal mass measuring 4.5×5.4×4.5 cm. Her blood pressure was 100/65 mm Hg. 24 hour urine catecholamine level and serum aldosterone level were normal ruling out pheochromocytoma and primary hyperaldosteronism. 24-hour UFC by liquid chromatography-mass spectrometry was 99.3 mcg/24 hours (4.0-50.0) with 24-hour creatinine 1.45 g/24hours (0.63- 2.50). After 1 mg dexamethasone suppression test, 8 a.m. cortisol level by immunoassay [IA] was 5.1 mcg/dl (2-10 equivocal) and dexamethasone level by extraction chromatography, IA was 39 ng/dl (180-550). The low dexamethasone level could be due to amyloidosis of GI tract causing malabsorption. Plasma ACTH by IA was <5 pg/ml (5-27). On further work up serum TSH by chemiluminescence was 0.19 mIU/L (0.40- 5.50), total T3 by IA was 35.34 ng/dl (60- 181), total T4 by IA was 3.2 mcg/dl (4.5-12.0), T3RU by spectrophotometry was 57.14% (24-40), FSH by IA was 0.99 mIU/ml (23.0-116). LH by IA was 0.07mIU/ml (10.0- 54.7). Reverse T3 by IA was 29 ng/dl (11-32) ruling out euthyroid sick syndrome. The patient is also being investigated for a myeloproliferative disorder due to platelet count of 1.3 million/ul.
In summary, this patient illustrates a presentation of SA with central hypothyroidism/ hypogonadism, which is extremely rare, and a possible cortisol secreting adrenal adenoma, which has not been reported previously.
Nothing to Disclose: ASS, GB, KP, AP, NGT
*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm
See more of: Abstracts - Orals, Featured Poster Presentations, and Posters