Adrenal incidentaloma in a patient with endometrial carcinoma and metabolic syndrome

A. Ghemigian, M. Cârșote, C. Vasiliu, A. Valea, A. Dumitrașcu, C. Grigoriu, S.E. Albu

Rezumat: Introduction. Metabolic complications (MC) may be caused by an active adrenal tumor (AT) as Conn’s, Cushing’s syndrome; however a secondary site of a previous carcinoma may involve adrenals. Objective. We present endocrine panel of a menopausal woman with MC and cancer to whom differential diagnosis need to be clarified in front of a newly discovered AT. Material and method. Hormonal assays are detailed. Results. In 2015, a 64-year-old female is admitted for accidentally discovered AT (of 2.89/3.6/3.2 cm). In 2011 she was diagnosed with endometrial carcinoma and total hysterectomy with bilateral anexectomy was done with local radiotherapy added. She associated high-risk MC as: type 2 diabetes mellitus, high blood pressure, hyperlipemia, chronic ischemic heart disease, persistent atrial fibrillation, hyperuricemia, and an episode of stroke (complicated with left hemiplegy). On admission, the serum sodium and potassium were normal while the endocrine profile revealed non-secretor profile: plasma metanephrines = 10 pg/mL (Normal: 10-90 pg/mL), plasma normetanephrines = 20 pg/mL (Normal: 15-180 pg/mL), plasma baseline ACTH = 8.04 pg/mL (Normal: 3-66 pg/mL), baseline morning plasma cortisol = 14.97 μg/dL (Normal: 6.2-11.9 μg/dL), morning plasma cortisol after dexametasone suppression test =3 μg/dL (Normal: <1.8 μg/mL), chromogranin A = 20 ng/mL (Normal: 20-125 ng/mL). The patient was followed for one more year, and clinical, hormonal and imagery aspects were status quo. Conclusion. Adrenal incidentaloma may represent a challenge if metabolic complications are already diagnosed and a secretor pattern might be involved, and if a prior cancer is treated, the adrenal mass raises the question of a secondary spreading.
Cuvinte cheie: endometrial cancer, adrenal tumor, high blood pressure, obesity.