Endocrine Abstracts

Introduction: Primary aldosteronism is presented with signs of hypertension and hypokalaemia classically, however, primary adrenal carcinoma is very rare condition. We aimed to present a patient with a metastatic adrenal carcinoma after the primary diagnosis of hyperaldosteronism.

Case report: A 46 years old male patient was referred to our hospital with weakness, dry mouth and weight loss. He had lost weight as 31 pounds during last 3 months. Physical examination revealed diffuse crackles in lungs. The others system examination was found normal without any organomegaly or lymphadenopathy. Arterial tension was measured 170/100 mmHg, serum sodium 140 mEq/dl, potassium 1.9 mEq/dl at admission. Differential diagnosis was planned on uncontrolled hypertension and persistent hypokalaemia with elevated aldosterone levels and low renin levels as 753 ng/dl (3–28 ng/dl) and 0.57 ng/ml per h (0.65–5 ng/ml per h) respectively. After potassium replacement therapy, potassium was 3.1 mEq/dl. Doxazosin 8 mg/day with spironolactone 100 mg/day was started. Supression was established with 1 mg dexamethasone in cortisol level. In thorax–abdominal CT was showed bilateral diffuse nodules (biggest was nearly ~2.5 cm) in lungs were consisted with metastatic cancer. A giant mass with 12 cm diameter in suprarenal region, which involves liver partially, consisted with adrenal gland tumour was determined. The miliary tuberculosis ruled out by bronchoscopy. Metastatic multiple hyper-metabolic lesions in lungs and hyper-metabolic mass in surrenal region were detected in positron emission tomography. Fine needle aspiration biopsy was performed from right surrenal mass with CT scan. Pathology revealed adrenocortical carcinoma. Chemotherapy (mitotane) was the chosen treatment because of the distant metastases. Patient died during the chemotherapy.

Conclusions: Primary adrenal carcinoma is very rare with annual incidence of one per one million populations. Less than 1% of all secrete aldosterone. Also clinicians should be aware that primary hyperaldosteronism could occur in the context of adrenocortical carcinoma.