Adrenocortical carcinoma posing as a pheochromocytoma: a diagnostic dilemma

Jain, Sumita; Agarwal, Lakshman; Nadkarni, Shravan; Ameta, Atul; Goyal, Ashish; Kumar, Ripusudan; Rao, Arjun; Gupta, Kamalkant

doi:10.1093/jscr/rju030

Cited by 6 publications

(4 citation statements)

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“…In our patients the relation between density and the histopathological diagnosis has not always occurred, as in cases of radiologically suspected adrenal cancer or myelolipoma (Fig. 5), which were diagnosed by histopathological study as adrenal hyperplasia (34)(35)(36)(37)(38). The N-Ph group from our study composed of 9 adenomas, all with density >10 HU , which indicates them as "lipid poor" adenomas (39).…”

Section: Discussionmentioning

confidence: 61%

Predictive Value of Chromogranin A in a Diagnosis Towards Pheochromocytoma in Adrenal Incidentaloma

et al. 2016

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context. Some adrenal tumors, such as pheochromocytoma, can be life-threatening. Therefore it is crucial to distinguish them from other lesions, especially prior to surgery. Chromogranin A (CgA) seems to potentially be a good marker for tumors of chromaffin origin.objective. To assess the differentiating value of CgA in the diagnostic work-up of pheochromocytoma.design. Retrospective study of operated patients with adrenal incidentaloma with lesions > 10 Hounsfield's units (HU) on CT.subjects and methods. Thirty patients (11 males, 19 females; aged 61.5±21 years) were enrolled in the study. Patients using medications interfering with the assessment of CgA and metanephrines were excluded. Two groups were formed: those with pheochromocytoma (Ph, n=16) and those with non-pheochromocytoma (N-Ph, n=14) lesions. Data included radiological features of masses, serum CgA and 24-hour urine metanephrines (24 -HUM) concentrations.results. No difference in 24-HUM level nor tumor size or density was found between groups Ph and N-Ph. Median serum CgA concentration was higher in Ph group compared to the ) ng/mL, respectively (P=0.04). In Ph group, the size of the lesion correlated negatively with density (r= -0.53, P=0.042). No significant correlation in CgA, 24-HUM, density or size of the lesion was found. Performed curve receiver operating characteristic (ROC) showed AUC=0.7232 for CgA. Taking into account CgA serum value of ≤ 50 ng/mL (sensitivity: 93.75%, specificity: 50.00%, P=0.012), we proposed an algorithm for management of lesions > 10 HU on CT.conclusion. CgA level ≤ 50 ng/mL might be useful in initial screening evidence for the exclusion of pheochromocytoma. It is crucial to eliminate factors interfering with the measurements.

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Section: Discussionmentioning

confidence: 61%

Predictive Value of Chromogranin A in a Diagnosis Towards Pheochromocytoma in Adrenal Incidentaloma

et al. 2016

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“…But there was a misclassification of the tumor in the initial histology report. e considerable difficulty associated with differentiation between adrenocortical (ACC) and medullary (pheochromocytoma) tumor with a high degree of anaplasia was previously noted in the medical literature [5]. Even though comparatively higher nuclear pleomorphism and the presence of hyaline globules in the cytoplasm are characteristics of pheochromocytoma those are not specific for the tumor [6].…”

Section: Discussionmentioning

confidence: 99%

An Adrenocortical Carcinoma Associated with Non-Islet Cell Tumor Hypoglycemia and Aberrant ACTH Production

Dilrukshi

Wickramarachchi

Abeyaratne

et al. 2020

Case Reports in Endocrinology

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Introduction. Adrenocortical carcinomas (ACCs) are infrequently reported to present with severe hypoglycemia syndrome resulting from the secretion of insulin-like growth factor II (IGF-II) by tumor cells. Adrenocorticotropic hormone- (ACTH) independent hypercortisolism is the norm of hormonally active ACCs, but aberrant ACTH production by tumor cells can theoretically cause ACTH-dependent hypercortisolism. The purpose of this report was to present a case of an ACC manifested with the co-occurrence of two extremely rare presentations. Case Description. We present a rare case of a 43-year-old male patient admitted with recurrent episodes of severe non-ketotic and non-insulin-mediated hypoglycemia due to IGF-II mediated disease and ACTH-dependent Cushing’s syndrome. He was diagnosed with a diffusely disseminated adrenocortical carcinoma with immunohistochemistry of tumor cells showing focal ACTH immunostain positivity. Conclusion. Non-islet cell tumor hypoglycemia and ACTH-dependent Cushing’s syndrome are extremely rare presentations of an ACC, and co-occurrence of these entities in a single patient is never reported in the literature.

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“…Артериальное дав-ление повышается до очень высоких значений, отме-чается тахикардия. В литературе описаны наиболее характерные случаи этого редкого состояния [17,18].…”

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