Cushing syndrome and adrenal carcinoma: clinic case

Abstract

 A 21 year-old girl arrived at our hospital with a short history of hirsutism, facial pletora, amenorrhea, progressive weight gain and hypertension.

The clinically suspected Cushing syndrome was then confirmed through chemical pathology.

In fact, the results from haemato-chemical exams were: 45.5 Ìg/dl cortisol, a DHEA sulphate > 8000 ng/ ml, 7.2 pg/ml ACTH, 17OH-Progesterone 10.66 ng/ml, Delta-4 Androstenedione 5.2 ng/ml, UFC (Urine Free Cortisol) > 1000mg/24h, FSH 0.8 mUI/ml, LH <0.1 mUI/ml, Prolactin 13, 17‚estradiol 96 pg/ml, and a bonded hypokalaemia, K+ 2,4 mEq/L. The echogram of the complete abdomen reveals, near the superior pole of the left kidney, the presence of a solid mass, not independent from the pole itself, about 9.5 centimetres long, diagnosis confirmed to the TC abdomen and pelvis too, with or without mdc.

This removed mass resulted, from the histological exam, in an adrenal carcinoma with a general and trabecular structure.

Primal adrenal tumours are responsible for about 10% of Cushing syndrome cases. They present an annual incidence of 0.5 - 2.0 cases per million of inhabitants.

The prognosis of adrenal ca remains low, with 5 year survival rate for 38% of diagnosed patients.