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Incidentalom adrenal la o pacientă cu cancer endometrial şi sindrom metabolic

 Adrenal incidentaloma in a patient with endometrial carcinoma and metabolic syndrome

Conf. Univ. Dr. Adina Ghemigian, Mara Carsote, Cristina Vasiliu, Ana Valea, Anda Dumitrașcu, Corina  Grigoriu

First published: 15 noiembrie 2016

Editorial Group: MEDICHUB MEDIA

Abstract

Introduction. Metabolic complications (MC) may be caused by an active adrenal tumor (AT) as Conn’s, Cushing’s syndrome; however a secondary site of a previous carcinoma may involve adrenals. Objective. We present endocrine panel of a menopausal woman with MC and cancer to whom differential diagnosis need to be clarified in front of a newly discovered AT. Material and method. Hormonal assays are detailed. Results. In 2015, a 64-year-old female is admitted for accidentally discovered AT (of 2.89/3.6/3.2 cm). In 2011 she was diagnosed with endometrial carcinoma and total hysterectomy with bilateral anexectomy was done with local radiotherapy added. She associated high-risk MC as: type 2 diabetes mellitus, high blood pressure, hyperlipemia, chronic ischemic heart disease, persistent atrial fibrillation, hyperuricemia, and an episode of stroke (complicated with left hemiplegy). On admission, the serum sodium and potassium were normal while the endocrine profile revealed non-secretor profile: plasma metanephrines = 10 pg/mL (Normal: 10-90 pg/mL), plasma normetanephrines = 20 pg/mL (Normal: 15-180 pg/mL), plasma baseline ACTH = 8.04 pg/mL (Normal: 3-66 pg/mL), baseline morning plasma cortisol = 14.97 µg/dL (Normal: 6.2-11.9 µg/dL), morning plasma cortisol after dexametasone suppression test =3 µg/dL (Normal: <1.8 µg/mL), chromogranin A = 20 ng/mL (Normal: 20-125 ng/mL). The patient was followed for one more year, and clinical, hormonal and imagery aspects were status quo. Conclusion. Adrenal incidentaloma may represent a challenge if metabolic complications are already diagnosed and a secretor pattern might be involved, and if a prior cancer is treated, the adrenal mass raises the question of a secondary spreading. 
 

Keywords
endometrial cancer, adrenal tumor, high blood pressure, obesity

Rezumat

Introducere. Factorii de risc metabolic şi cardiovascular diagnosticaţi la un pacient ar putea fi în esenţă datoraţi unei tumori suprarenale secretante similare cu cea cauzatoare de sindrom Conn sau Cushing; mai mult, adrenalele pot găzdui ca sediu secundar un carcinom. Obiectiv. Să introducem tabloul endocrin în menopauză al unei paciente care asociază atât tulburări metabolice, cât şi un istoric de neoplasm, context ce necesită un diagnostic diferenţial atent al tumorii adrenale. Material şi metodă. S-au utilizat pentru acest caz datele bazate pe dozările endocrine, ginecologice şi imagistice. Rezultate. O pacientă de 64 de ani este internată în 2015 pentru relevarea fortuită a unei tumori suprarenale (de 2,89/3,62/3,2 centimetri). În 2011, pacienta fusese diagnosticată cu un carcinom endometrial tratat prin histerectomie totală cu anexectomie bilaterală şi ulterior cu radioterapie locală. Doamna prezenta profil cardio-metabolic cu risc ridicat, dat de asocierea: diabet zaharat de tip 2, hipertensiune arterială, hiperlipemie, boală coronariană, fibrilaţie atrială permanentă, diateză urică, istoric de accident vascular. La internare, sodiul şi potasiul seric au fost normale, cu dozările următoare: metanefrine plasmatice de 10 pg/mL (normal între 10 şi 90 pg/mL), normetanefrine plasmatice de 20 pg/mL (normal între 15 şi 180 pg/mL), ACTH bazal matinal de 8,04 pg/mL (normal între 3 şi 66 pg/mL), cortizol plasmatic bazal matinal de 14,97 µg/dL (normal între 6,2 şi 11,9 µg/dL), cortizol plasmatic după testul de supresie la dexatemazonă de 3 µg/dL (normal sub 1,8 µg/dL), cromogranina A de 20 ng/mL (normal între 20 şi 125 ng/mL). Pacienta a fost urmărită un an, fără modificări semnificative clinice sau dozimetrice. Discuţii. Identificarea unei tumori adrenale în astfel de circumstanţe implică multiple specialităţi, de la oncologia ginecologică, cardiologie la endocrinologie. Concluzie. Incidentalomul adrenal ar putea asocia dificultăţi de confirmare a profilului specific dacă se asociază complicaţii metabolice sau, pentru pacienţii cu istoric oncologic, o masă adrenală poate ascunde o metastază.
 

Cuvinte cheie
endometrial cancer tumoră adrenală hipertensiune arterială obezitate

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