Endocrine Abstracts

A 59-year-old male patient, who is fit and well, presented with abdominal discomfort, night sweats, back pain and lower urinary tract symptoms. The CT scan, organised by the GP, demonstrated a 17 cm heterogenous mass with central necrosis and scattered calcification in right side of abdomen, possibly right adrenal origin or liver or kidney. He was referred to Adrenal MDT. Baseline functional testing showed unsuppressed cortisol level in an overnight dexamethasone, high DHEA sulphate level and low ACTH. He does not have any features of hypercortisolism. PET CT scan showed large right suprarenal mass with intense FDG activity and necrosis, compatible with an adrenocortical carcinoma and no FDG avid metastatic disease demonstrated. He was planned for adrenalectomy. He did not need medical therapy for hypercortisolism prior to surgery as he was completely asymptomatic and blood pressure was well controlled. He underwent an open right adrenalectomy with no immediate complications. The histopathology showed oncocytic adrenal cortical carcinoma with vascular invasion, PT2 pNx (TNMv8), no capsular invasion, Ki 67 8.7%. He was started on hydrocortisone tablets post-surgery. Short synacthen test 6 weeks post-surgery showed an adequate cortisol response. He was reviewed in Oncology clinic in view of histopathology finding. After discussion with Histopathology for tumour grading, it was regarded as very low grade by Helsinki scoring system (Helsinki score 13) and no adjuvant therapy is needed. He will be closely monitor with surveillance CT scans. He remains well and is waiting for the surveillance CT scan. Further plan from Endocrinology includes testing of 9 am cortisol off morning hydrocortisone to assess his adrenal axis. Oncocytic variant is a rare subtype of adrenocortical cancer and there is less guidance available for post operative period care. Helsinki scoring system is used for prognosis and a score more than 17 is associated with adverse prognosis.