Endocrine Abstracts

Introduction: We describe a case of young girl, who initially presented with androgen producing adrenal adenoma, and post-operatively, the other adrenal gland profoundly cortisol suppressed, raising suspicion, if it was originally co-producing both androgen and cortisol.

Case report: A 29-year-old girl initially presented, with 8 months history of hirsutism and cranial hair loss.

She had a normal menarche and menstrual cycles and conceived two children without difficulty and no suggestion of early virilisation.

Examination showed facial and abdominal hirsutism, but no clinical features of Cushing’s syndrome.Blood tests showed raised testosterone 5.3 nmol/l (normal <1.5 nmol/l), raised androstenedione 18.7 nmol/l (normal <6 nmol/l) and normal DHEAs of 4.9 μmol/l.

Her aldosterone renin ratio was normal at 284 and 1000 h cortisol was 466.

CT scan demonstrated a well circumscribed 5 cm right adrenal mass with no concerning features.She had a laparoscopic left adrenalectomy and the tumour stain positively with calretinin, melan-A and inhibin, confirming adreno-cortical origin.

However 6 weeks post-operatively she presented with ongoing tiredness and a short synacthen test showed sub optimal cortisol increase from 150 to 339 nmol/l. She was commenced on hydrocortisone and test repeated 6 weeks later, which re-confirmed that the other adrenal gland is still suppressed with cortisol values increasing from 24 to just 70 nmol/l. Due to profound suppression of the contra lateral adrenal gland, it is possible that the adenoma was co secreting both androgen and cortisol. Interestingly she had an uneventful surgery and immediate post-op period without any steroid cover.

Conclusion: Although clinically she was not Cushingoid, she could have had screening for Cushing’s pre-operatively, as she might have developed acute adrenal crisis during the surgery, due to the suppression of the other adrenal and luckily it did not happen in our case.