Endocrine Abstracts

Introduction: We report a case of a 72-year-old man who was incidentally discovered to harbour a large right adrenal mass during evaluation for resistant hypertension and subsequently diagnosed with an androstenedione and oestrogen secreting adrenocortical tumour.

Case report: A 72-year-old gentleman presented with unilateral gynecomastia which was previously investigated with a mammogram and biopsy (normal) to rule out breast cancer. Two years later, he presented to the cardiology department with poorly controlled hypertension and shortness of breath. He had history of ischemic heart disease, heart failure with preserved ejection fraction. His cardiac MRI revealed an incidental right-sided adrenal mass measuring 12 × 15 × 18 cm. He was referred for endocrine evaluation which identified significantly elevated dehydroepiandrosterone sulphate >27 µmol/l [0.91 -6.76], androstenedione 33.2 nmol/l [1.5-6.5], oestradiol 421 pmol/l [95-233], and progesterone 1.2 nmol/l [0.2-0.5]. FSH was suppressed 1.3 IU/l [1.5-12.4] with normal LH 1.9 IU/l [1.7-8.6]. Plasma renin activity 1.9 nmol/l/hr [0.5-3.5 nmol/l/hr], aldosterone 250 pmol/l [90-700 pmol/l], plasma metanephrines, metadrenaline 122 pmol/l [80-510], normetadrenaline 555 poml/l [120-1180 pmol/l], 3-methoxytyramine <180 pol/l [<180 pom/l] and 9 am cortisol 299 nmol/l [172-497 nmol/l] levels were all within normal range. A FDG PET-CT scan showed avid uptake by the adrenal mass, suggestive of a metabolically active lesion, an I-123 MIBG scan showing the mass was non-avid. A multidisciplinary discussion by the adrenal team meeting (MDT) resulted in a decision to proceed with a right adrenalectomy which happened uneventfully. Postoperative hormone profile showed a marked reduction in dehydroepiandrosterone sulphate and oestradiol levels to 0.7 µmol/l and 206 pmol/l respectively. Histological examination confirmed an oncocytic adrenocortical tumour with Ki-67 index 3%. The surveillance imaging showed a residual lesion accompanied by a normal repeat hormonal profile. He is scheduled for a repeat FDG PET scan in June 2024 to monitor for potential tumour recurrence.

Conclusion: Adrenal oncocytic neoplasms (AON) are indeed rare tumours, with only around 287 cases reported in the literature. Among these cases, only 30% display metabolic function, with hyperandrogenism and Cushing syndrome observed in 13.2% and 8% of AON patients, respectively. This case underscores a delayed diagnosis and an incidental finding during cardiovascular assessment, highlighting the significance of a thorough diagnostic evaluation that includes imaging and hormonal profiling for conditions like gynecomastia and resistant hypertension. By contributing to the global literature, this case report emphasizes the crucial role of adrenal surgery in managing these rare solid neoplasms.