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[Unusual endocrine behavior in adrenal carcinoma. A case study]
M Zingrillo1, M Errico, L D'Aloiso
1Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia).
Minerva Endocrinologica
|October 1, 1991
Summary
A patient with an incidentally discovered adrenal mass developed Cushing's syndrome months after surgery. Despite treatment, the adrenal cancer progressed to metastatic disease, leading to death.
Area of Science:
- Endocrinology
- Oncology
- Surgical Pathology
Background:
- Adrenal masses are often incidentally discovered.
- Early-stage adrenal masses may not present with hormonal hypersecretion.
- Adrenalectomy is a common treatment for adrenal masses.
Observation:
- A 40-year-old man with an incidentally discovered left adrenal mass underwent adrenalectomy.
- Post-operative follow-up showed no clinical or hormonal abnormalities for 8 months.
- The patient later presented with symptoms of severe hypercortisolism, including edema, hypertension, hypokalemia, and alkalosis.
Findings:
- Elevated plasma and urinary cortisol levels confirmed Cushing's syndrome.
- Imaging revealed a large adrenal mass with diffuse hepatic metastases.
- The adrenal cancer recurred and progressed systemically despite mitotane and ketoconazole therapy.
Implications:
- This case highlights the potential for delayed presentation of Cushing's syndrome from adrenal tumors.
- It underscores the importance of long-term monitoring for patients with adrenal masses, even after initial negative workups.
- The rapid progression and poor outcome emphasize the aggressive nature of some adrenal cancers and the limitations of current therapies.