Endocrine Abstracts

A 57 year old man with a history of hypertension and type 2 diabetes mellitus (HbA1c 80 mmol/mol) presented with right sided flank pain and weight loss. He reported a history of intermittent palpitations and headaches. CT with contrast demonstrated a right renal mass and right adrenal mass. MRI adrenal showed a 2.4 cm T2 hyperintense right adrenal lesion that demonstrated a stricture diffusion with no signal dropout on out of phase imaging and a 2 cm mass in the upper pole of the right kidney. He was referred to the endocrine clinic for review of the adrenal mass and diabetes management pre-operatively. Biochemical evaluation of the adrenal mass revealed elevated plasma metanephrines, normetanephrine 2640 pmol/l(0-1180), metanephrine 2190 pmol/l(0-510) and 3-metoxytyramine <100 pmol/l(0-180). He was commenced on doxazosin for blood pressure management and diabetes care was optimised in the peri-operative setting. He underwent a robotic right radical nephrectomy and adrenalectomy. Histology confirmed a clear cell renal cell carcinoma (RCC) limited to the kidney and an encapsulated tumour (30 mm) in the adrenal gland (PASS score 2). Post-operatively, his plasma metanephrine has normalised. His blood glucose levels have improved (HbA1 c 53 mmol/mol). There was no family history of RCC, phaeochromocytoma or paraganglioma. He subsequently underwent genetic testing which did not identify any genetic mutation. Our patient may yet have a genetic mutation that has yet to be found and further screening could be considered in the future.