January - March 2020, Volume 16, Issue 1

Liu C, Zhang H, Li X

Subclinical Cushing’s syndrome, renal carcinoma, adrenal adenoma, adrenal incidentaloma.

Acta Endo (Buc) 2020, 16 (1): 97-102
doi: 10.4183/aeb.2020.97

Context. Patients with renal malignancies present high risk of adrenal hyperplasia and adenoma, and part of these are primary lesions, mostly non-functional. Here we presented a case diagnosed as primary adrenal adenoma with autonomous cortisol secretion accompanied by homolateral renal cell carcinoma. Case presentation. A 79-year-old woman was referred for evaluation of a left adrenal mass, with a past medical history of severe hypertension, diabetes, and hyperlipidemia. On examination, no clinical signs of cushingoid features were found. Biochemical measurements showed plasma cortisol was 12.77 μg/dL and was not suppressed by 1 mg dexamethasone (DXM) overnight test (13.6 μg/dL). The contrast CT scan presented a 2.2 cm diameter adrenal mass and revealed, unfortunately, a hyperdense mass at the middle-upper pole of the left kidney. Laparoscopic nephrectomy with left adrenalectomy was performed and pathological examination indicated a final diagnosis of benign adrenocortical adenoma and renal clear cell carcinoma. At 2 months postoperatively, without replacement treatment of cortisol, a recovery of circadian rhythm of cortisol secretion was detected, indicated recovery of the hypothalamic-pituitary-adrenal axis. Conclusions. Patients with renal cancer might be accompanied with functional adrenal adenoma. Therefore, screening for adrenal function should be recommended in patients with renal tumors and/or adrenal incidentaloma.

Keywords: Subclinical Cushing’s syndrome, renal carcinoma, adrenal adenoma, adrenal incidentaloma

Correspondence: Xiaohua Li PhD, Shanghai University of Traditional Chinese Medicine, Department of Endocrinology, Seventh People’s Hospital of Shanghai, Shanghai, 201203, China, E-mail: wendylee_tcm@shutcm.edu.cn