Unusual presentations of adrenocortical tumours

Omar Mustafa; Ben Whitelaw; Rebeka Jenkins; Tiana Kordbacheh; Paola Salaris; Chris Manu; Norman Taylor; Roy Sherwood; Gill Vivian; Dylan Lewis; Klaus-Martin Schulte; Salvador Diaz-Cano; Jackie Gilbert; Alan McGregor; Simon Aylwin

doi:10.1530/endoabs.31.P107

Background: Adrenocortical tumours (adenoma or carcinoma) present in well-recognised ways: hormones excess (Cushing’s, Conn’s, virilisation) or hormonally silent with symptoms of mass effect, or found incidentally on imaging. We present 3 cases of adrenal tumours, referred to our regional adrenal multidisciplinary meeting with unusual presenting features.

Case 1: post-menopausal bleeding: A previously well 57-year-old female presented with vaginal bleeding 5 years after completing menopause. She was not using exogenous oestrogen. Hysteroscopy demonstrated endometrial hyperplasia. Subsequently, she developed right-sided abdominal pain. Imaging revealed 6 cm invasive right adrenal mass. Serum oestradiol and 17β-oestradiol were elevated. Oncological right adrenalectomy was performed. Histology confirmed invasive adrenocortical carcinoma. Serum oestradiol fell to post-menopausal levels. No further vaginal bleeding was noticed.

Case 2: polycythaemia: A previously well 49-year-old female was noted to have hypertension and polycythemia (haemoglobin 17 g/dl). Venesection (following a haematology opinion) was unsuccessful in controlling polycythaemia. Subsequently, significant weight gain and increased body hair over the preceding year were noted. She had features of Cushing’s syndrome, marked hirsutism and increased muscle tone. Investigations showed high serum testosterone (23 nmol/l) and elevated non-suppressible serum cortisol. Imaging showed 3.5 cm left-sided well-circumscribed adrenal lesion. It was treated with laparoscopic left adrenalectomy. Histology demonstrated oncocytic adrenocortical adenoma. Post-operatively, cortisol and testosterone levels normalised and polycythaemia resolved.

Case 3: hypertension and low serum aldosterone: A 27-year-old female presented with 6-month history of hypertension, hypokalaemia (2.8 mmol/l) and low serum aldosterone (86 pmol/l, range 100–450 pmol/l). She subsequently developed abdominal pain. Imaging revealed 10 cm left adrenal lesion. Serum cortisol was suppressed (<30 nmol/l) after overnight dexamethasone (1 mg). Urinary and plasma catecholamines/metanephrines were normal. Urinary steroid profile demonstrated marked increases of metabolites of 11-deoxycortisol(S) and 11-deoxycorticosterone. Histology from the oncological resection of the mass revealed adrenocortical adenoma. Hypertension resolved post-operatively.

Discussion: These three cases represent rare presenting features of adrenal tumours.

Endocrine Abstracts

P107