Endocrine Abstracts

Introduction

Adrenal tumors represent an increasingly common problem in modern endocrine practice. The diagnostic approach can be challenging and occasionally reveals surprising features like mixed hormonal secretion: aldosterone-and-cortisol producing adenoma. This rare situation can also impact on the therapy and the post-operative management. In this context, we report 5 patients who are followed in the Endocrinology department in Hedi Chaker hospital, sfax, Tunisia for adrenal mixed tumors.

Purpose

The aim of our study was to describe the clinical and data of these patients and monitor their evolution after appropriate treatment.

Methods

A retrospective study of patients who have cortico and or medullary mixed tumors.

Results

We objected Aldosterone- and cortisol-co-secreting tumors in four cases and corticomedullary mixed tumors in one case. All patients were female aged between 42 and 76 years old, and the average age was 59 years old. No particular family medical history was found. All patients had hypertension and type 2 diabetes. Obesity was described in one case and overweight in the others. Two patients were referred to our departement for adrenal incidentaloma, 2 for recent and resistant hypertension and 1 for hypokaliema. Medical examination revealed high blood pressure in one patient and cushing manifestation in one patient. No neuromuscular signs nor paroxysmal seizures were noted. Laboratory finding revealed hypercortisolism in all patients associated to hyperaldosteronism in 4 cases and catacholamine excess in one case. Adrenalectomy was performed to all patients without incidents. Histopathological study revealed 1 case of corticomedullary adenoma, 3 cases of mixed adrenocortical adenoma and one case of myelolipoma associated with mixed adrenocortical adenoma. After a follow up of 7 years, patient with corticomedullary adenoma showed multiple cardiovascular incidents. These incidents were myocardial infarction, ischemic stroke and peripheral arterial occlusive disease. An Uncontrolled diabetes was also noted during her monitoring. In the other patients with co-secetion cortisol and aldosterone, 3 patients had steady evolution after 1.5 years of follow up. However, one patient developed contralateral adrenal adenoma.

Conclusion

Mixed adrenal adenoma are rare. The clinical suspicion of cortisol co-secretion by an APA and corticomedullary adenoma can be confirmed bay hormones tests. In addition, a more detailed histological and molecular work-up of such lesions may inform us on additional ways of development of adrenal autonomy.