Endocrine Abstracts

Introduction: Adrenal carcinomas are rare aggressive endocrine tumours with an incidence of 1–1.7 per 1 000 000. Sixty percent of patients present with symptoms of excess hormone secretion, most commonly as hypercortisolism, with or without virilisation due to accompanying androgen secretion. Tumours without clinical hormonal excess most often present with symptoms such as abdominal discomfort or back pain due to tumour growth.

Case report: A 72-year-old male patient with a history of type 2 diabetes mellitus was admitted to the hospital with severe hyperglycemia. Medical history revealed arterial hypertension and a lesion of the left adrenal gland (44×36 mm). Laboratory evaluation showed elevated levels for leucocytes, glucose and HbA1c as well as low levels of potassium. Initial chest X-ray showed a suspicious left hilus. Further studies, including CT thorax and MRI of the abdomen, showed evidence of multiple pulmonary, lymphatic, muscular and mediastinal metastases. Bone scintigraphy was inconspicuous. Owing to clearly progress of adrenal tumour size (62×46 mm), the patient underwent extensive endocrinological work-up. Blood tests showed elevated levels of cortisol, DHEA, androstendione and 17-OH-progesterone. ACTH was suppressed. Dexamethasone suppression test showed no suppression. In conclusion metastasised adrenal carcinoma was suspected. Biochemical evaluation was followed by a sonographically controlled biopsy of the mediastinal metastasis which confirmed the diagnosis of a hormononally active adrenal carcinoma. A chemotherapy with mitotane, 5-FU and streptozotocine was started, potassium was substituted. Hyperglycemia was controlled by an intensive insulin therapy. Hypercortisolism persisted but unfortunately the patient eventually decided against ketoconazole or any further therapy.

Conclusions: An adrenal carcinoma may present with severe hyperglycemia and hypokalaemia. Further investigations, including endocrine testing and imaging, are needed to detect the underlying tumour.