Large Adrenal Mass Presenting With Clinical Cushing's Syndrome And Hyperaldostronism

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 1-36-Adrenal Incidentaloma & Carcinoma
Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-35
Fatima Al kaabi1 and Muhammad Houri*2
1AL Ain Hospital, Al Ain, United Arab Emirates, 2Al-Ain Hospital, Al Ain, United Arab Emirates
Introduction: hypercortisolism  should be suspected in patients presenting with rapid Weight gain, DM and HTN espicially when  patient has no FHx of DM or HTN

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.

Conclusion

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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