Endocrine Abstracts

A 71-year-old woman was referred to the urology department with macroscopic haematuria. An ultrasound scan revealed a suspicious solid mass measuring 6.6cm arising from the left kidney. Subsequent CT scan confirmed the presence of a left adrenal mass along with omental and peritoneal disease and small-volume ascites. The patient was referred to the adrenal surgeons for consideration of left adrenalectomy in view of suspected adrenal cancer. At the surgical outpatient department, the patient reported experiencing palpitations and occasional headaches. She had a history of hypertension and was taking verapamil and perindopril. Her blood pressure was 185/105mm Hg, raising suspicion of phaeochromocytoma. Hormonal testing revealed elevated levels of 24-h urine normetanephrine (17.9 µmol/24h; reference range: 0.6-3.5) and urine metanephrine (72.8 µmol/24h; reference range: 0.2-1.5), confirming the diagnosis. The patient was referred to the adrenal and upper gastrointestinal multidisciplinary teams (MDT). The adrenal MDT concluded that the imaging findings were consistent with adrenal involvement and peritoneal disease, likely malignant. An ultrasound-guided biopsy of the peritoneal lesion was recommended. Meanwhile, the patient was seen in the endocrinology clinic and started on doxazosin while continuing verapamil. No significant omental thickening suitable for biopsy was identified. Instead, a biopsy was taken from the left adrenal lesion, confirming the morphological features and immunohistochemical profile of phaeochromocytoma. The differential diagnosis included primary peritoneal malignancy with adrenal metastases, malignant phaeochromocytoma, or dual pathology. A MIBG scan was performed, showing increased uptake in the left adrenal mass consistent with phaeochromocytoma. Omental and peritoneal disease was not observed PET CT scan revealing hypermetabolic phaeochromocytoma, FDG-avid peritoneal and omental disease, and multiple bony metastases. The biopsy of omental lesion confirmed serous adenocarcinoma of primary peritoneal or ovarian origin. The patient was referred to the oncology department for chemotherapy, but unfortunately developed bowel obstruction and passed away at home.