Endocrine Abstracts

Introduction: Adrenal tumors are commonly discovered incidentally on cross-sectional abdominal imaging. The Incidence of adrenal tumors increased 10-fold in the past 2 decades, with most diagnosed in older adults. In any patient with a newly discovered adrenal mass, determining whether it is functioning adenoma or non-functioning and identifying whether it is ACTH dependent or not is crucial to avoid missing the real underlying pathology.

Clinical case: A 40 years old female was referred to Endocrinology team by surgeons after having assessment for incisional hernia around the umbilical area and was found to have an incidental right adrenal adenoma of 4 cm size. She has past medical history of polycystic ovaries and reported excessive hair growth, acne and weight gain { 133 Kg }. Her pre clinic screening investigations showed normal urinary cortisol and normal baseline ACTH but with significantly raised Androgens. Her Testosterone and DHEAS levels were reducing with dexamethasone suppression test but post Dexamethasone cortisol was 71 nmol/lconfirming cortisol excess. Subsequent clinical examination and further assessment confirmed the presence of Cushing’s disease and currently she is awaiting pituitary surgery

Outcome: In presence of large adrenal mass, it is important not to miss a co-existence of pituitary dependent Cushion’s disease. The utilisation of urine cortisol and ACTH as a screening for autonomous cortisol secretion in adrenal mass work up can be falsely reassuring and a high index of suspicion is needed especially in symptomatic patients