Endocrine Abstracts

A 31-years-old female was admitted to our hospital because of prolonged fever of unknown origin for 2 months. As she was originally diagnosed to have upper respiratory infection, antibiotics and antipyretic analgesics were prescribed. However, there is a recurrence of fever up to 39 °C without antipyretic analgesics. There were no changes in body weight or the size of clothes, and she did not notice any clinical features of Cushing’s syndrome. Her height and weight was 152 cm and 58 kg, with BMI of 24.9 kg/m², and the blood pressure was 118/78 mmHg. Except light moon face like change and conjunctive anemia, she had no abnormal physical features including Cushing’s syndrome such as buffalo hump, truncal obesity, or purple striae. C-reactive protein and WBC were 15.7 mg/dl and 8900 /μl, respectively. Hemoglobin level was decreased to 9.2 g/dl, and platelet count was 609×103. ACTH was 12.3 pg/ml while serum and urine cortisol levels were 26.3 μg/dl and 246 μg/day, respectively. A normal circadian rhythm was not present. Dexamethasone suppression testing (0.5, 1.0, and 8.0 mg) did not decrease serum cortisol levels to the reference levels. Abdominal CT scan revealed left adrenal mass with a diameter of 55 mm, which was weakly enhanced, and was also consisted of the poorly enhanced region, suggesting the necrosis inside the mass. While there were no high uptakes in I-131 MIBG, adosterol, or gallium scintigraphys, (18)-FDG–PET/ CT scan showed high uptake only in left adrenal mass. As we diagnosed her adrenocortical carcinoma (ACC) with stage 1 and Cushing’s syndrome, adrenalectomy was performed. Histopathologic analysis revealed at least four parameters of the Weiss system, including atypical mitoses, high mitotic rate, or capsular invasion, and MIB-1 labeling index was over 10%. Adjuvant treatment with mitotane (o,p,-DDD) was initiated following surgery.

Not only the serum IL6 level, which showed elevated to 126 pg/ml before adrenalectomy, immediately decreased to 4.7 pg/ml, but also the fever and systemic inflammatory responses improved. IL6 is known to have various functions such as inducing B cell proliferation or systemic inflammatory responses, including elevations in ESR or CRP. We hypothesized the possibility of IL6 producing ACC or that IL6 elevation was part of the response for necrotic area of ACC, produced from endothelial.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.