Endocrine Abstracts

Introduction: Adrenal glands consist of two parts: adrenal cortex and adrenal medulla acting as two separate organs due to distinct structure, function and embryologic origin. Corticomedullary mixed tumor is an adrenal tumor mass which consists of mixed population of both adrenal cortical cells and medullar chromaffin cells.

Case report: A 36-year-old woman was admitted to our Clinic with hypertensive episode, headache and palpitation. Ultrasound and CT confirmed right adrenal tumor, size of 55 mm. Active pheochromocythoma was confirmed by elevated urinary catecholamines and serum chromogranine A. Endocrine evaluations revealed normal midnight cortisol, basal ACTH with adequate cortisol suppression after 1 mg-DST. PRA and aldosteron were also in normal range with normal ALD/PRA ratio. After careful administration of alpha-blockers (phenoxybenzamine) surgery was performed. Pathohistology and immunohistochemistry of the tumor showed mixed corticomedullary tumor with element of pheohromocythoma and adrenocortical adenoma. Adrenocortical cells expressed melanin A, inhibin, calretinin, and synaptophysin and medullar component expressed chromogranin A and synaptophysin with a few sustentacular S100 positive cells. Postoperatively, urinary catecholamines and serum chromogranine A were in normal range.

Conclusion: We presented a case of pheochromocythoma in a patient with confirmed corticomedullary mixed adrenal tumor which are quite rare. Clinical cases like this one underline the significance of thorough endocrine evaluation of every patient with adrenal tumor. The tumorigenesis of these tumors remains open.