Endocrine Abstracts

Adrenal incidentaloma (AI) in patients with cancer poses diagnostic challenge for doctors. We present clinical case of generalised metastatic bone diseases and adrenal mass.

Male 59 years old asked the second opinion about incidental adrenal mass, which was suspected for adrenal cancer by urologist. His medical anamnesis began in April of 2015 with severe generalised bone pain. The whole body MRI/CT detected multiple bone lesions, adrenal mass (57×45×56 mm, 37 HU) and prostate mass. Urologist studied PSA and carried out prostate biopsy, the results excluded prostate cancer. Basing on size and CT dencity of adrenal mass, the urologist suspected adrenal cancer and prepared to perform adrenal biopsy. First, he decided to get an endocrinologist consultation to exclude pheochromocytoma and ask the second opinion about suspected adrenal cancer. There were excluded pheochromocytoma, subclinical Cushing and adrenal insuficiency. Taking into accout the fact that adrenal cancer metastasis affect liver and lung first, which were abcent in this case, lack of rapid growth of adrenal mass, the suspected diagnosis of adrenal cancer was hardly probable. The suggestion for adrenal biopsy was refused because of hematologic disturbances and potential hemorrhage. Also there was made an offer to perform the bone lesion biopsy, which is easier and safer to perform. The results were consistent with multiple myeloma. Patient was seen by hematologist, the appropriate treatment assigned. The interesting fact was that the hematologic, bony and urinary signs, which are typical for myeloma, were abcent. Unfortunately, patient died after second cource of chemotherapy.

This case illustrates as diagnostic as administrative issues. First, the urologist did not follow the diagnostic protocol for adrenal incidentalomas, which would have been fatal. Secondly, the management of AI in cancer or suspeceted cancer patients should be absolutely multidisciplinary. Thirdly, untypical signs of the disease requires doctors to be more educated in edjacent specialities.