A Rare case of Desoxycorticosterone (DOC) adrenal normotensive adrenal tumor
2020
A 31 year-old man was admitted with low back pain
(LBP).He had LBP since four months ago. He also suffered
from severe weakness since one year ago. He had anorexia and
about 8 kilogram weight loss during last year. He also
complained of polydipsia and polyuria. Physical examination
revealed tenderness on L2 vertebrae and loss of dorsiflexion in
left foot and positive left SLR. Physical exam was normal
otherwise. Vital signs were normal and blood pressure was
110/70. Hypokalemia ranged from 1.4-3mg/dl was detected.
24 hour urinary volume was 3850cc and urine specific gravity
was 1006. 24 hour urinary potassium concentration was
54meq/L (normal range=25-125). Lateral lumbosacral
radiography showed decreased bone density, intervertebral
space and vertebral height. These findings did not signify the
low back pain. CT scan of lumbosacral vertebras showed lithic
destructive lesion at body of L2 accompanied with L1-L2
intervertebral disc involvement and paravertebral abscess.
Metastatic bone lesion was the radiologic diagnosis. In order
to confirm the nature of the lesion open biopsy was done.
Metastatic adenocarcinoma was the anatomical diagnosis.
Abdominal ultrasonography showed a70x150 millimeter
lobulated mass with irregular border in retroperitoneal space
next to spine with left kidney invasion. Abdominal and pelvic
CT scan showed left adrenal mass with several calcification
focuses and pesoas muscle involvement. Other organs were
normal. Hypokalemia had induced nephrogenic diabetes
insipidus and polyuria and polydipsia. For evaluation of
hypokalemia several laboratory tests were conducted.
Aldosterone was low and plasma rennin activity was low.
Other hormonal evaluations were normal. According to
laboratory data’s mineralocorticoid excess other than
aldosterone was considered and deoxycorticosterone level was
measured which was high (4.3ng/ml). After correction of
hypokalemia, surgery proceeded and adrenal mass removed.
The pathologic exam revealed a 11x7x5 centimeter mass with
large necrotic and hemorrhagic focuses and cells with
vesiculated, nucleolated nucleous accompanied with
numerous mitotic and also atypical mitosis in some foci and
granular eosinophilic cytoplasm, indicating adrenal
carcinoma. According to Weiss system, pathologic staging
was IV. Hypokalemia resolved after surgery. The patient was
referred for radiation treatment of vertebrae after he was
discharged. After radiation, adjuvant treatment with Mitotan
2g /day was instituted and no recurrence was observed up to
24 months follow up.
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