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Abstract Disclosure: A.C. Lee: None. M.D. Rosario: None. Adrenocortical oncocytoma is often non-functioning and detected incidentally. We report a case of a functioning adrenal oncocytic neoplasm referred for adrenal incidentaloma. She is a 33-year-old female hypertensive and diabetic, had 10-kilogram weight gain in a span of one year, with easy bruisability, and irregular menses for the last 10 months. Physical examination showed moon facies, buffalo hump, purple-colored violaceous striae measuring 1.2-1.4 cm in diameter, thin skin and hirsutism. There was an incidental finding of a left adrenal mass measuring 3.0 x 2.9 x 3.0 cm on CT scan. Work-up done: 1-mg dexamethasone suppression test (DST) with unsuppressed 8am cortisol at 948 nmol/L (reference range (RR) 172- 303), ACTH 1.00 pg/ml (RR 3.0 – 30.0); Total 24-hour urine metanephrine 136 mcg/24 hours (RR 115-695); Normal Plasma Aldosterone Concentration 169pg/ml (RR 57-335), and Plasma Renin Activity 21.4pg/mL (RR 5.4-34.5). She was referred for further evaluation and definitive management. CT scan with adrenal protocol showed an enhancing isodense mass in the lateral limb of the left adrenal (3.2 x 3.1 x 2.9 cm). Plain, venous and delayed Hounsfield Unit respectively as follows: +47, +84, +72 with absolute and relative wash out at 32.4 % and 14.3% respectively, worrisome for neoplasm versus metastasis. The right adrenal is unremarkable. Repeat work up showed unsuppressed 1-mg DST at 17.90 ug/dL (RR 1.8) with low 4pm ACTH 2.14 pg/ml (RR: 3.00 - 30.00). Dehydroepiandrosterone Sulfate low 3.40 ug/dL (RR: 95.80 - 511.70) with normal plasma free metanephrine 10.31pg/ml (RR: 65pg/ml). She was assessed to have ACTH-independent Cushing syndrome secondary to adrenal mass to consider malignancy and underwent left laparoscopic adrenalectomy. Pre-operatively, hydrocortisone 50 mg intravenously was given and continued every 6 hours intra-operatively. Histopathology revealed adrenal cortical adenoma with oncocytic features , tumor size 3.3 cm in widest dimension, with low mitotic tumor grade (20 mitoses per 10 millimeter square). Lymphatic and vascular invasion was not identified and all surgical margins were negative for tumor. Postoperatively, hydrocortisone was shifted to prednisone and tapered. Six months post operatively, 8 am serum cortisol (24-hour post steroid discontinuation) was adequate at 20 ug/dL with gradual improvement in the patients Cushing’s features. Nine months post-adrenalectomy, there was resumption of her regular menses and twelve months thereafter total weight loss was at 13 kilograms. Physical examination showed a remarkedly lighter violaceous striae with decreased hirsutism. Whole abdominal CT scan twelve months post operation was unremarkable. Recurrence and metastases have been described in patients with an adrenal oncocytic carcinoma post-surgery hence our patient will be closely followed-up to check for any recurrence or metastases. Presentation: 6/1/2024
Lee et al. (Tue,) studied this question.