Endocrine Abstracts

Introduction: An undefined lesion detected by imaging methods in one or both adrenals is known as an incidentaloma. The size and capacity of the secretion are evaluated to determine its definitive management. It is extremely uncommon for a mixed adrenal incidentaloma to appear with elevated cortisol and medullar hormone output.

Case report: A 21-year-old woman was admitted to the hospital with intermittent palpitations, headaches, and chest pain. She was already receiving medication for her diabetes and hypertension. The Cushing syndrome symptoms (’moon-face’, ’lemon-on-sticks’), with a BMI of 25 kg/m², a BP of 140/90 mmHg, and a PR of 75/min, were found during the examination. There was no history of hirsutism, menstruation irregularity, or fractured bones.

Results: Hematology and biochemistry tests, in addition to U&E, were routine. Following a thorough wash-out, additional laboratory tests revealed non-suppressible morning serum cortisol in ODST and HDDT. The levels of dopamine, epinephrine, nor-epinephrine, and 24-hour urine metanephrines were all increased, as well as the serum CgA. An abdominal MDCT showed a normal left adrenal gland and an enlarged right adrenal gland (36.4×30 mm). No abnormal findings were detected on the pituitary MRI. The patient received an open right adrenalectomy following complete preoperative treatment with alpha and beta blockers. A mixed corticomedullar tumor with no malignant alterations was identified by the histology.

Discussion and Conclusion: A tumor made of chromaffin cells known as a pheochromocytoma exhibits symptoms and signs of elevated sympathetic activity. A cortisol-producing adenoma is the most frequent cause of Cushing’s syndrome, which manifests as hypertension, diabetes mellitus, central obesity, proximal muscle weakness, purple striae, bone fractures, and irregular menstruation in females. We describe a rare example of a combined corticomedullar tumor of the right adrenal gland that simultaneously secreted cortisol and medullary hormones.

Keywords: Pheochromocytoma, Cushing syndrome, Adrenal incidentaloma