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Four additional patients underwent a second AVS due to other reasons: two due to inconclusive LI (LI between 3 and 4), one due to mismatch between aldosterone/cortisol ratio between the first and second right adrenal vein samples, and one patient who relapsed in PA after an initially successful resection of aldosterone producing adrenal adenoma. All these four procedures were successful.
Adrenal collision tumor: Renal carcinoma metastasis within adrenal adenoma. Clin Biomed Res 2015; 35:169-171.
Kim, "Characterization of lipid-poor adrenal adenoma: Chemical-shift MRI and washout CT," American Journal of Roentgenology, vol.
In a review of 25 studies looking at a total of 87,065 autopsies, adrenal adenomas were found at a rate of 6%, with a range of 1-25% among the studies [4].
Three months later, left adrenalectomy was performed and histological examination confirmed an adrenal adenoma.
(1) Cushing's syndrome is associated with (i) ingestion of prescribed glycocorticoids, (ii) a pituitary ACTH-secreting corrticotroph adenoma (Cushing disease account for most cases), (iii) cortisol secreting adrenal adenomas and carcinomas, and (v) ectopic corticotrophinreleasing hormone (CRH) or ACTH secretion by bronchial carcinoids and other rare tumors.
All patients with carcinoid, pheochromocytoma, pancreatic NET, prostatic adenocarcinoma, GIT NET, medullary thyroid carcinoma, schwannoma, lung small cell carcinoma, adrenal adenoma, and parathyroid adenoma had raised CgA values.
A contrast enhanced computed tomography (CT) of abdomen according to the adrenal protocol showed a right-sided homogenously dense (density of 9.5 Hounsfield Units {HU}) adrenal lesion measuring 1.6 x 1.3 x 0.8 cm with an absolute washout of 67% confirming benign nature of the lipid rich adrenal adenoma (Figure 1).
Fatty component was present in renal angiomyolipoma and adrenal adenoma. Calcifications were present in renal cell carcinoma, lymph node mass, and in hydatid cyst.
The resected tumor was a benign ACTHindependent adrenal adenoma. One week after surgical removal of the adrenal tumor, her plasma cortisol and ACTH levels in the early morning (8:00) were <1 ig/dl and 8.93 pg/ml, respectively, and at midnight (24:00) they were 1.01 ig/dl and 5.81 pg/ml, respectively.
In another case reported the cat presented adrenal adenoma, insulinoma and parathyroid adenoma (REIMER et al., 2005).
Based on guidelines from the Endocrine Society, primary aldosteronism should be suspected in young patients with moderate to severe hypertension, patients with hypertension and coexisting hypokalemia, any patient with hypertension and an incidental adrenal adenoma, and hypertension in the setting of a significant family history of early onset hypertension or cerebral vascular accident in a first degree relative less than 40 years of age (1).
Histology confirmed the presence of three separate tumours: a renal vein leiomyosarcoma, a RCC, and an adrenal adenoma. To date, no similar cases have been reported.
There was no difference in the mean total score on the MFS between patients treated for CD (mean: 13.3 [+ or -] 7.8) and cortisol-producing adrenal adenoma (mean: 16.1 [+ or -] 5.5; P = 0.3).
Conversely, reporting a benign adrenal adenoma as metastasis will imply advanced disease, potentially denying the patient definitive treatment and potential cure.