Endocrine Abstracts

Introduction: Incidence of neuroendocrine neoplasms is still growing very rapidly. Many of these tumours are long term asymptomatic, definitive diagnose is confirmed in very advanced stage and make treatment difficult. Our case report illustrates diagnostic contribution of endoscopic adrenal biopsy.

Our patient was a woman, 68 years old in time of diagnosis, with good quality of life. One year before she was undergone hysterectomy with bilateral adnexectomy for postmenopausal bleeding. Small ovarian neuroendocrine tumour (G1, MiB1 <5%) with small parts off benign Brenner’s tumor was found in right ovary. Postoperative octreotide scan was found adrenal gland tumours on both sides (size 2 and 3 cm), not accumulating somatostatine analogue, suspected from feochromocytoma.

Patient was completely asymptomatic, with mild hypertension treated with monotherapy, mild and stable hypothyroidism and chronic asthmatic bronchitis, treated with inhalation corticosteroid.

Hormonal screening of adrenal function did not reveal any abnormality, feochromocytoma was excluded by low levels of plasmatic metanephrines and only pathologic finding was slightly elevated chromogranine A (203 ng/ml). Therefore, we performed adrenal biopsy (by uncomplicated esophagogastroduodenoscopy with transduodenal biopsy), from left adrenal gland (anatomically more accessible) was gained successful sample for cytological and histologic assessment – microscopically were found cell clusters with hyperchrome nuclei with anisonucleosis und small amount of cytoplasm, made diagnosis of neuroendocrine tumour metastasis almost certain.

According to this result, palliative chemotherapy (etoposide+carboplatine) was started and patient is still without symptoms and disease is stabilised.

Conclusion: Endosonography-guided biopsy could be useful tool in examining patients with adrenal tumours of unknown origin and could help to earlier diagnostics.