Follow-up of second adrenal tumor after remission of Cushing syndrome
Bilateral adrenal tumors (BAT) represent a vast domain of endocrinology and connected medical and surgical fields. Our purpose is to introduce several key points in relationship with long time management on a 56-year old female case who is currently admitted for reassessment of a left adrenal tumor...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Amaltea Medical Publishing House
2021-12-01
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| Series: | Romanian Journal of Medical Practice |
| Subjects: | |
| Online Access: | https://rjmp.com.ro/articles/2021.4/RJMP_2021_4_Art-20.pdf |
| _version_ | 1827342613463695360 |
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| author | Mihai Cristian Dumitrascu Diana Elena Rentea Stefania Zugravu Claudia Mehedintu Mara Carsote Florica Sandru |
| author_facet | Mihai Cristian Dumitrascu Diana Elena Rentea Stefania Zugravu Claudia Mehedintu Mara Carsote Florica Sandru |
| author_sort | Mihai Cristian Dumitrascu |
| collection | DOAJ |
| description | Bilateral adrenal tumors (BAT) represent a vast domain of endocrinology and connected medical and surgical fields. Our purpose is to introduce several key points in relationship with long time management on a 56-year old female case who is currently admitted for reassessment of a left adrenal tumor with potential
autonomous cortisol secretion. She is also known with pituitary incidentaloma since 2014, cerebral meningioma which was partially removed in 2015, uncontrolled diabetes mellitus under metformin and insulin therapy since 2017, and high blood pressure since 2021. Her medical history includes right adrenalectomy for Cushing syndrome in 2014. At that moment, she was first admitted for BAT, a tumor of 2 centimeters (cm) on the left gland according to computed tomography, respective of 3.5 cm maximum diameter on the right adrenal. The hormonal panel confirmed adrenal Cushing syndrome. After 6 months of non-interventional follow-up, the right tumor increased to 4 cm, also associating small areas of necrosis, thus a decision of unilateral laparoscopic adrenalectomy was done with good clinical post-operatory outcome. She did not develop adrenal insufficiency at any point in time, moreover, a low-normal ACTH
(Adrenocorticotrop Hormone) with intermittent elevation of morning plasma cortisol levels after Dexamethasone suppression test showed a possible autonomous cortisol secretion of the left adrenal tumor during a 7-year follow-up. In 2014, the female patient received the confirmation of an adrenocortical
adenoma which was consistent with cortisol over-secretion. Particular gene contributions are attributed to protein kinase A (PKA) defects (or B) that usually induce bilateral adrenocortical hyperplasia; however, they are not routinely tested in daily endocrine practice, neither had we performed it. Interestingly, the patient was detected with a cerebral meningioma after years of intermittent, mild headache. The diagnostic was established during initial endocrine evaluations. The headache was not associated with uncontrolled high blood pressure, as first expected due to excessive cortisol amount. Recently, it was identified that mutations of ARMC5 (armadillo repeat containing 5) gene are responsible for macronodular adrenal hyperplasia, but also meningioma. They may be also responsible for severe diabetes mellitus as seen here. The key points of following a patient with bilateral adrenal tumors include the timing of uni/bilateral adrenalectomy, the multidisciplinary management of associated complications, as well as the need of understanding the genetic rational behind it. |
| first_indexed | 2024-03-07T22:10:10Z |
| format | Article |
| id | doaj.art-6bbec054783448e19b3e383ebc228ad6 |
| institution | Directory Open Access Journal |
| issn | 1842-8258 2069-6108 |
| language | English |
| last_indexed | 2024-03-07T22:10:10Z |
| publishDate | 2021-12-01 |
| publisher | Amaltea Medical Publishing House |
| record_format | Article |
| series | Romanian Journal of Medical Practice |
| spelling | doaj.art-6bbec054783448e19b3e383ebc228ad62024-02-23T15:52:38ZengAmaltea Medical Publishing HouseRomanian Journal of Medical Practice1842-82582069-61082021-12-0116450951510.37897/RJMP.2021.4.20Follow-up of second adrenal tumor after remission of Cushing syndromeMihai Cristian Dumitrascu0Diana Elena Rentea1Stefania Zugravu2Claudia Mehedintu3Mara Carsote4Florica Sandru5University Emergency Hospital, Bucharest, Romania; “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania “C.I. Parhon“ National Institute of Endocrinology, Bucharest, Romania “C.I. Parhon“ National Institute of Endocrinology, Bucharest, Romania “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania; “Nicolae Malaxa” Clinical Hospital, Bucharest, Romania “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania; “C.I. Parhon“ National Institute of Endocrinology, Bucharest, Romania“Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania; Elias Emergency Hospital, Bucharest, RomaniaBilateral adrenal tumors (BAT) represent a vast domain of endocrinology and connected medical and surgical fields. Our purpose is to introduce several key points in relationship with long time management on a 56-year old female case who is currently admitted for reassessment of a left adrenal tumor with potential autonomous cortisol secretion. She is also known with pituitary incidentaloma since 2014, cerebral meningioma which was partially removed in 2015, uncontrolled diabetes mellitus under metformin and insulin therapy since 2017, and high blood pressure since 2021. Her medical history includes right adrenalectomy for Cushing syndrome in 2014. At that moment, she was first admitted for BAT, a tumor of 2 centimeters (cm) on the left gland according to computed tomography, respective of 3.5 cm maximum diameter on the right adrenal. The hormonal panel confirmed adrenal Cushing syndrome. After 6 months of non-interventional follow-up, the right tumor increased to 4 cm, also associating small areas of necrosis, thus a decision of unilateral laparoscopic adrenalectomy was done with good clinical post-operatory outcome. She did not develop adrenal insufficiency at any point in time, moreover, a low-normal ACTH (Adrenocorticotrop Hormone) with intermittent elevation of morning plasma cortisol levels after Dexamethasone suppression test showed a possible autonomous cortisol secretion of the left adrenal tumor during a 7-year follow-up. In 2014, the female patient received the confirmation of an adrenocortical adenoma which was consistent with cortisol over-secretion. Particular gene contributions are attributed to protein kinase A (PKA) defects (or B) that usually induce bilateral adrenocortical hyperplasia; however, they are not routinely tested in daily endocrine practice, neither had we performed it. Interestingly, the patient was detected with a cerebral meningioma after years of intermittent, mild headache. The diagnostic was established during initial endocrine evaluations. The headache was not associated with uncontrolled high blood pressure, as first expected due to excessive cortisol amount. Recently, it was identified that mutations of ARMC5 (armadillo repeat containing 5) gene are responsible for macronodular adrenal hyperplasia, but also meningioma. They may be also responsible for severe diabetes mellitus as seen here. The key points of following a patient with bilateral adrenal tumors include the timing of uni/bilateral adrenalectomy, the multidisciplinary management of associated complications, as well as the need of understanding the genetic rational behind it. https://rjmp.com.ro/articles/2021.4/RJMP_2021_4_Art-20.pdfadrenal tumorbilateral adrenal tumorcushing syndromeadrenalectomycortisolendocrineadrenal incidentalomasecondary diabetes mellitussecondary osteoporosis |
| spellingShingle | Mihai Cristian Dumitrascu Diana Elena Rentea Stefania Zugravu Claudia Mehedintu Mara Carsote Florica Sandru Follow-up of second adrenal tumor after remission of Cushing syndrome Romanian Journal of Medical Practice adrenal tumor bilateral adrenal tumor cushing syndrome adrenalectomy cortisol endocrine adrenal incidentaloma secondary diabetes mellitus secondary osteoporosis |
| title | Follow-up of second adrenal tumor after remission of Cushing syndrome |
| title_full | Follow-up of second adrenal tumor after remission of Cushing syndrome |
| title_fullStr | Follow-up of second adrenal tumor after remission of Cushing syndrome |
| title_full_unstemmed | Follow-up of second adrenal tumor after remission of Cushing syndrome |
| title_short | Follow-up of second adrenal tumor after remission of Cushing syndrome |
| title_sort | follow up of second adrenal tumor after remission of cushing syndrome |
| topic | adrenal tumor bilateral adrenal tumor cushing syndrome adrenalectomy cortisol endocrine adrenal incidentaloma secondary diabetes mellitus secondary osteoporosis |
| url | https://rjmp.com.ro/articles/2021.4/RJMP_2021_4_Art-20.pdf |
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