Endocrine Abstracts

Case history: A 60-year-old male underwent left sided orchidectomy for a Seminoma in November 2005. As a part of work up for the Seminoma, he was noted to have bilateral adrenal masses which raised the possibility of metastasis.

Investigations: CT scan of the abdomen showed 22 mm mass on the right with a Hounsfield units of −31 and a 12 mm mass on the left with Hounsfield units of −1. The radiological phenotype of these masses along with density measurements were consistent with benign adenomas rather then metastasis. Biochemical assessment confirmed endocrinologically inactive masses with normal overnight 1 mg dexamethasone suppression test and two normal 2400 h urine estimations for catecholamines.

Treatment: Post operatively, he has responded well to chemotherapy and there is no evidence of tumour recurrence. Radiological surveillance for adrenal adenomas was carried out by the oncologists together with surveillance for tumour recurrence with plan to refer to endocrine team if there is evidence of enlargement of adrenal masses. Endocrine follow was lost and hence no endocrine surveillance was carried out for 6 years.

CT assessments in 2008 and 2009 showed no change, however in 2012 it was noted that the right adrenal lesion had increased to 3.2 cm and a further endocrine assessment was sought.

He was seen in endocrine clinic recently and remains asymptomatic and now awaits further biochemical assessment given the increasing size of adenoma and review of his serial radiology after the images have been repatriated to our department.

Conclusions and points for discussion.: Biopsy of adrenal mass in the context of previous malignancy, current increasing size and normal endocrine investigations.

Acceptable length of hormonal and radiological surveillance of solitary adrenal lump, discussion of guidelines which are mostly American and their impact on UK healthcare resources if these are followed.