Endocrine Abstracts

Malignant neoplasm of the Adrenal gland is rare and carries a poor prognosis. Presentation is with either symptoms of hormone excess; Cushings Syndrome (Steroids), Conns Syndrome (Aldosterone), Virilisation (Androgens), Feminisation (Oestrogens), Phaeochromocytoma (Catecholamines) or abdominal mass, and patients often present with hypertension. Laboratory investigations confirm clinical suspicion of isolated hormone excess. Surgical resection offers the best chance for long-term survival and is the treatment of choice.

Here we present two unusual cases of Adrenal Carcinoma presenting with hypertension. Laboratory investigation confirmed concurrent excess secretion of both Cortisol and Aldosterone, and imaging revealed the presence of an adrenal mass. Both were treated by laparoscopic adrenalectomy.

Immunohistochemical analyses of surgically excised adrenal neoplasms reveal that tumour cells clinically secreting one hormone in excess often retain the necessary enzymes for the production of other adrenal hormones. Tumours secreting Mineralocorticoids and Corticosteroids in excess are rare. Nevertheless, metabolites of both should be investigated in cases of Cushings Syndrome or Aldosteronism in order to facilitate adequate pre-surgical treatment of hypertension and whole body potassium depletion, and avoidance of post-operative adrenal crisis respectively.