From benign adrenal incidentaloma to adrenocortical carcinoma: an exceptional random event.
Eur J Endocrinol. 2017 Mar 27;:
Authors: Belmihoub I, Silvera S, Sibony M, Dousset B, Legmann P, Bertagna X, Bertherat J, Assie G
New European guidelines for the management of adrenal incidentalomas were recently released. One of the most novel recommendations is to stop following patients when they present a typical, small and non-secreting adenoma. We report here the case of a 71-year-old man with such an adenoma, who developed an adrenocortical carcinoma (ACC) fourteen years later, with subsequent metastases and death. Clinically he had a normal blood pressure and no sign of hormonal hypersecretion. The hormonal work-up showed no hormone excess: urinary free cortisol level was normal, the diurnal cortisol rhythm was respected and urinary catecholamine metabolites levels were normal. Computed tomography (CT) scan showed a homogeneous lesion, with a low density. The lesion remained unchanged during the five years of follow-up. Eight years after the last CT, a large right heterogeneous adrenal mass was incidentally discovered during an ultrasound examination. On CT-scan it was a 6 cm heterogeneous tumor. On hormonal work-up there was no secretion. The patient was operated of an adrenalectomy and the histology described an ACC with a Weiss score at 8, with no benign contingent. To our knowledge this is the first case of an ACC occurring in a patient with prior adrenal imaging showing a typical benign adenoma.
PMID: 28348073 [PubMed - as supplied by publisher]