Session: MON 1-36-Adrenal Incidentaloma & Carcinoma
Poster Board MON-35
Case : 27 year old male presented with rapid weight gain, new onset DM, HTN and proximal muscle weakness.
He has no FHx of DM or HTN.
On exam BP was 185/105 he has Cushingoid features (round face, acne, buffalo hump, and supraclavicular fat pads wide purple striate and proximal muscle weakness)
He reported about 10 KGs weight gain in the year prior to presentation.
Night time cortisol was significantly elevated (566 nmol/l) as well as am cortisol after 1 mg dexamethasone suppression test (589 nmol / L ,normal less than 50). 24 urine cortisol was 633 mcg/24 hours (nl less than 50) potassium was low at 2.4 at time of presentation .
ACTH was suppressed ; supine aldosterone was mildly elevated 0.51 nmol/L, normal 0.44 along with low renin(6.8 nmol/l Nl 7-44). Both were measured after correction of potassium.
No further testing for aldosterone was done till after surgery
24 urine metanephrines were normal
CT adrenal glands revealed right adrenal mass measuring 4.2 X 2.8 cm, the left galnd was normal.
Laparoscopic RT adrenalectomy was performed without complication
Post surgery, am cortisol was very low 14 nmol/l and aldosterone was below normal (0.05 nmol/l)along with renin at high end of normal range
Pathology findings were consistent with adrenal adenoma.
After surgery both DM and HTN resolved as well as the muscle weakness.
This patient presented with classic symptoms of hypercortisolism along with hypokalemia, low renin and elevated aldosterone. After surgery the elevation in cortisol and aldosterone resolved. It is not uncommon to encounter adrenal adenomas which co-secrete cortisol and aldosterone. And sometimes patients may have two adenomas.Our patient had one single large adenoma. With elevated cortisol and aldosterone , both resolved after adrenalectomy. His clinical presentation was concerning for adrenocortical carcinoma ( young male with rapid development of symptoms over 9 months with a large mass, without the typical density for adenoma ) however on pathology the tumor was benign with no evidence of malignancy.
Nothing to Disclose: FA, MH
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