Endocrine Abstracts

Introduction: Adrenocortical oncocytomas are rare seen tumours. Most of these tumours are benign and non-functioning. We present here a case of oncocytic adrenocortical tumour, detected incidentally, presented with Cushing’s syndrome.

Case: A 41-year-old male patient, while investigating for abdominal pain, bilateral adrenal masses were detected in abdominal ultrasonography and was admitted to Endocrinology Clinic. He had no history of hypertension. Physical examination revealed, a pulse rate of 80 beats/min and a blood pressure of 180/90 mmHg. Patient had typical cushingoid appearance including a plethoric moon face, truncal and centripetal obesity and abdominal cutaneous striae. In his laboratory investigations; glucose level was 97 mg/dl, ALT 80 U/l (30–65), cortisol 18.47 μg/dl (5–23), DHEAS >1000 μg/dl (35–560), and ACTH <5 pg/ml (9–52). In the 24-h urine metanephrine level, normetanefrin and plasma aldosteron concentration, plasma renin concentration were normal. Other biochemical blood test results were within normal ranges. The plasma cortisol level was 24 μg/dl after 1 mg overnight, 22 μg/dl after 2 days 2 mg dexamethasone suppression test, and midnight cortisol was 14 μg/dl. According to these findings Cushing’s syndrome was considered. Surrenal magnetic resonance imaging (MRI) that showed bilateral adrenal adenomas that were 35×32 mm in size in the right and 78×64 mm in the left adrenal gland, isointense in T1A and T2 and included cystic regions. Left adrenalectomy was performed to the patient. The postoperative histopathological diagnosis was borderline oncocytic adrenocortical tumour with myelolipoma foci and Ki-67 proliferation index was under 1%. The patient is still under follow-up at our clinic with the replacement therapy of steroid.

Conclusion: The incidence of adrenal incidentaloma is increasing according to technological development and frequency of radiological imaging. Adrenocortical oncocytomas are rare seen tumours. Most of these tumours are benign and non-functioning. Some of that tumours are malign and while the others are borderline. Oncocytic neoplasms microscopically consist of so called oncocytes, large cells with rich eosinophilic granulations due to the high concentration of mitochondria. We present a case with oncocytic adrenocortical tumour presented with Cushing’s syndrome because it is seen rare.