1
|
Wang Z, Zhong X, Yu J, Li H, Zheng J. Ectopic adrenocortical adenoma characterized by hypogonadism: a case report and review of the literature. J Med Case Rep 2024; 18:276. [PMID: 38863038 PMCID: PMC11167918 DOI: 10.1186/s13256-024-04595-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/17/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Currently, there is a scarcity of cases and diagnostic data regarding ectopic adrenocortical adenomas, particularly in relation to their impact on gonadal function and localization diagnostic techniques. We report a typical case of ectopic adrenocortical adenomas and the data of treatment follow-up, and review the literature of 31 available cases of ectopic adrenocortical adenomas. CASE PRESENTATION A 27-year-old Chinese female patient was admitted to our hospital for hypertension, hyperglycaemia and primary amenorrhea. The patient was functionally diagnosed with ACTH-independent CS and hypogonadotropic hypogonadism. Radiological evaluations, including Computed Tomography (CT) and functional imaging, identified a mass at the left renal hilum. Histological assessments post-surgical excision confirmed the mass to be an ectopic adrenocortical adenoma. A subsequent 3-month follow-up showed no signs of disease recurrence, a swift recovery of the cortisol axis was observed, with a partial recuperation of the gonadal axis. REVIEW Our literature review shows that the most common ectopic areas of cortisol adenomas are renal hilum and hepatic region. The most positive biomarker is Melan A, and only a few cases have been diagnosed with functional localization. CONCLUSION Ectopic adrenocortical adenomas may be asymptomatic in the early stage and can impact gonadal function. Physicians who treat hypogonadism must be aware of the need to test cortisol levels and perform functional localization in patients with lumps present.
Collapse
Affiliation(s)
- Zhihua Wang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xueyu Zhong
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Jiayu Yu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Huiqing Li
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Juan Zheng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| |
Collapse
|
2
|
Lin D, Qin J, Xing J. Ectopic adrenocortical nodular hyperplasia mimicking an upper pole renal cell carcinoma: A case report. Asian J Surg 2022; 46:2156-2157. [PMID: 36456437 DOI: 10.1016/j.asjsur.2022.11.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dawei Lin
- Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China; Center of Diagnosis and Treatment of Urinary System Diseases, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China; The Key Laboratory of Urinary Tract Tumors and Calculi of Xiamen City, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China; The Third Clinical Medical College of Fujian Medical University, Xiamen, Fujian, 361003, China
| | - Jiaxuan Qin
- Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China; Center of Diagnosis and Treatment of Urinary System Diseases, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China; The Key Laboratory of Urinary Tract Tumors and Calculi of Xiamen City, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China.
| | - Jinchun Xing
- Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China; Center of Diagnosis and Treatment of Urinary System Diseases, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China; The Key Laboratory of Urinary Tract Tumors and Calculi of Xiamen City, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China.
| |
Collapse
|
3
|
Baek J, Kim SH, Cho SH, Kim WH, Kim HJ, Ryeom HK, Yoon G. Ectopic Adrenal Adenoma in Renal Sinus: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:1116-1120. [PMID: 36276201 PMCID: PMC9574275 DOI: 10.3348/jksr.2021.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/07/2022] [Accepted: 03/08/2022] [Indexed: 11/15/2022]
Abstract
The kidney is a rare site of ectopic adrenal adenoma. To the best of our knowledge, some cases of ectopic adrenal adenoma have been found in the kidney, but few of these cases explain the CT and MRI findings of the lesion. We reported a case of ectopic adrenal adenoma in the left renal sinus. A 47-year-old male patient underwent abdominal CT for routine health check-ups, which revealed a 1.2 cm enhancing mass in the left renal sinus. The MRI showed a signal drop of the mass in T1 weighted in- and opposed-phase, which indicates fat components. The mass was confirmed as an ectopic adrenal adenoma after surgery.
Collapse
|
4
|
Hao Z, Ding J, Huo L, Luo Y. ACTH-Independent Cushing’s Syndrome Caused by an Ectopic Adrenocortical Adenoma in the Renal Hilum. Diagnostics (Basel) 2022; 12:diagnostics12081937. [PMID: 36010286 PMCID: PMC9407005 DOI: 10.3390/diagnostics12081937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 11/25/2022] Open
Abstract
We report a rare case of Cushing’s syndrome induced by an ectopic adrenocortical adenoma. A 57-year-old woman was diagnosed with adrenocorticotropic hormone (ACTH)-independent Cushing’s syndrome based on clinical manifestation and laboratory information. She was found to have a mass in the left renal hilum via contrast-enhanced computed tomography (CT). The mass was negative, as seen in somatostatin receptor imaging with 99mTc-hydrazinonicotinyl-Tyr3-octreotide (HYNIC-TOC), and showed mild fluorodeoxyglucose (FDG) activity via positron emission tomography (PET)/CT. The results of adrenal venous sampling suggested a left-side adrenal origin of hypercortisolism, possibly secreted by the mass in the renal hilum. Histopathology after surgical resection of the mass confirmed an ectopic adrenocortical adenoma, which was responsible for the patient’s Cushing’s syndrome. During the 8-month follow-up after surgery, no recurrence of Cushing’s syndrome was found.
Collapse
Affiliation(s)
- Zhixin Hao
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing 100730, China
| | - Jie Ding
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing 100730, China
| | - Li Huo
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing 100730, China
| | - Yaping Luo
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing 100730, China
- Correspondence: ; Tel.: +86-010-69155513
| |
Collapse
|
5
|
Liu T, Lv R, Hu X, Li K, Ren Q, Zhang Y, Meng L, Liu Z, Guo Z, Cheng Y. Case report: An ectopic adrenocortical adenoma in the renal sinus. Front Oncol 2022; 12:934862. [PMID: 35965562 PMCID: PMC9366061 DOI: 10.3389/fonc.2022.934862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Ectopic adrenal tissue is rare in adults, with an incidence of only about 1%. We report a rare case of ectopic adrenocortical adenoma in the left renal sinus. Case Preentation A 57-year-old woman was admitted to the Department of Urology due to “a left kidney tumor” on physical examination. Multislice helical computed tomography (CT) showed the left kidney with an anterior lip mass near the hilum, approximately 2.3 cm × 2.2 cm in size. Preoperative renal artery CT angiography (CTA) showed no obvious abnormality. Laparoscopic resection of the left renal sinus mass was performed, and postoperative pathological findings showed ectopic adrenocortical adenoma. The tumor was a nonfunctional adenoma. Conclusion Renal ectopic adrenal cortical adenoma is rare. Most of them are nonfunctional adenomas, which cannot be clearly diagnosed by preoperative imaging examination and can often be diagnosed by postoperative pathology.
Collapse
Affiliation(s)
- Tianyu Liu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Renguang Lv
- Department of Urology, Jinan Seventh People’s Hospital, Jinan, China
| | - Xiaolin Hu
- Department of Endocrine, Jinan central hospital of Shandong University, Jinan, China
| | - Kewei Li
- Department of Urology, Zhucheng people’s Hospital Affiliated to Weifang Medical College, Weifang, China
| | - Qiangqiang Ren
- Department of Urology, Wucheng People’s Hospital, Dezhou, China
| | - Yongzhen Zhang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Liwei Meng
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhaoxu Liu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
- School of Nursing, Shandong University, Jinan, China
| | - Zhaoxin Guo
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Zhaoxin Guo, ; Yufeng Cheng,
| | - Yufeng Cheng
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Zhaoxin Guo, ; Yufeng Cheng,
| |
Collapse
|
6
|
Endo M, Fujii H, Fujita A, Takayama T, Matsubara D, Kikuchi T, Manaka S, Mori H. Ectopic adrenocortical adenoma in the renal hilum mimicking a renal cell carcinoma. Radiol Case Rep 2022; 17:619-622. [PMID: 34987692 PMCID: PMC8703184 DOI: 10.1016/j.radcr.2021.10.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 11/21/2022] Open
Abstract
Ectopic adrenocortical tissue can arise along the path of embryonic migration, such as the celiac axis, broad ligament, adnexa of the testis, and spermatic cord. Occasionally, ectopic adrenocortical tissues undergo marked hyperplasia and develop into ectopic adrenocortical adenomas. This report describes the case of a 60-year-old man who was incidentally found to have a lipid-containing mass with early enhancement and delayed washout in the right renal hilum. A renal cell carcinoma was suspected, and robot-assisted partial nephrectomy was performed, but the final diagnosis was an ectopic adrenocortical adenoma. We should include ectopic adrenocortical adenoma in the differential diagnosis when we find a lipid-containing tumor adjacent to the kidney.
Collapse
Affiliation(s)
- Masashi Endo
- Department of Radiology, Jichi Medical University, School of Medicine, Tochigi, Japan
| | - Hiroyuki Fujii
- Department of Radiology, Jichi Medical University, School of Medicine, Tochigi, Japan
- Corresponding author
| | - Akifumi Fujita
- Department of Radiology, Jichi Medical University, School of Medicine, Tochigi, Japan
| | - Tatsuya Takayama
- Department of Urology, Jichi Medical University, School of Medicine, Tochigi, Japan
| | - Daisuke Matsubara
- Division of Integrative Pathology, Jichi Medical University, School of Medicine, Tochigi, Japan
| | - Tomohiro Kikuchi
- Department of Radiology, Jichi Medical University, School of Medicine, Tochigi, Japan
| | - Saki Manaka
- Department of Radiology, Jichi Medical University, School of Medicine, Tochigi, Japan
| | - Harushi Mori
- Department of Radiology, Jichi Medical University, School of Medicine, Tochigi, Japan
| |
Collapse
|
7
|
Takedani K, Yamamoto M, Tanaka S, Ishihara S, Taketani T, Kanasaki K. ACTH-independent Cushing's syndrome due to ectopic endocrinologically functional adrenal tissue caused by a GNAS heterozygous mutation: a rare case of McCune-Albright syndrome accompanied by central amenorrhea and hypothyroidism: a case report and literature review. Front Endocrinol (Lausanne) 2022; 13:934748. [PMID: 35966069 PMCID: PMC9373900 DOI: 10.3389/fendo.2022.934748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
In a small number of cases, the development of ectopic residual adrenal lesions during embryogenesis causing Cushing's syndrome due to the production of excess cortisol has been reported. A 29-year-old woman was admitted to our hospital for fatigue and recent amenorrhea. Her plasma ACTH was <1.5 pg/mL, and her serum cortisol was 21.4 pg/mL after the 8 mg dexamethasone suppression test, revealing the presence of ACTH-independent Cushing's syndrome; however, her bilateral adrenal glands were atrophied. Abdominal CT revealed a 40-mm round tumor on the right renal hilum and remarkably accumulated 131I-labelled adosterol. CT and bone scintigraphy showed that 99mTc-methylene diphosphonate had accumulated in her dissymmetric skull at the right-frontoparietal region. The tumor on the right renal hilum was laparoscopically removed. Her cortisol levels rapidly decreased to below the normal range, and glucocorticoids were administered to rescue adrenal insufficiency. The resected tumor was yellowish in appearance and 4.5×3.0×2.8 cm in size. Immunohistochemical staining for SF-1, P450scc, CYP17A, CYP21A, and CYP11B1 indicated that this tumor produced cortisol. Exome sequencing analysis revealed that the GNAS heterozygous mutation (c.601C>T, p. Arg201Cys; accession number, NM_000516.5) was found in approximately 20% of the adrenal tumor sample. A mutation of GNAS, encoding the Gsα subunit that mediates GPCR signaling, causes the constitutive activation of adenylyl cyclase, resulting in hypersecretion of hormones regulated by the GPCR. GNAS mutation is one of the major genetic causes of cortisol-producing adrenal tumors independent of ACTH secretion. Considering the combination of GNAS mutation with one of the typical clinical triad characteristics, fibrous dysplasia of bone, we diagnosed this patient with McCune-Albright syndrome accompanied by ACTH-independent Cushing's syndrome caused by an ectopic residual adrenal tumor due to GNAS mutation. This case highlights that GNAS involves a previously unknown pathological mechanism in which inhibition of the natural elimination of remnant tissue leads to ectopic endocrine hypersecretion.
Collapse
Affiliation(s)
- Kai Takedani
- Internal Medicine 1, Shimane University Faculty of Medicine, Izumo, Japan
| | - Masahiro Yamamoto
- Internal Medicine 1, Shimane University Faculty of Medicine, Izumo, Japan
- *Correspondence: Masahiro Yamamoto,
| | - Sayuri Tanaka
- Internal Medicine 1, Shimane University Faculty of Medicine, Izumo, Japan
| | | | - Takeshi Taketani
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo, Japan
| | - Keizo Kanasaki
- Internal Medicine 1, Shimane University Faculty of Medicine, Izumo, Japan
| |
Collapse
|
8
|
De Marchi D, Tafuri A, Mantica G, Shakir A, Scarfò F, Passaretti G, Smelzo S, Proietti S, Rigatti L, Luciano R, Antonelli A, Pagliarulo V, Leonardi R, Giusti G, Gaboardi F. Ectopic adrenal tissue in the kidney: A systematic review. Arch Ital Urol Androl 2021; 93:481-488. [DOI: 10.4081/aiua.2021.4.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 09/23/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: Ectopic adrenal tissue in the kidney, including “Ectopic adrenal tissue” and “Adrenal-renal fusion”, is a rare event with a specific behavior which may be difficult to distinguish clinically from renal neoplasms. We performed a systematic review on ectopic adrenal tissue variants reported in the literature underlining its clinical aspects. Methods: Manuscripts which presented a case report or case series of ectopic adrenal tissue in the kidney were included even if published in original articles, reviews, or letters to the editor. A specific search on SCOPUS®, PubMed®, and Web of Science® database was performed. Only English language papers published in a period ranging between August 1991 and April 2020 were considered. Additionally, a case we had at our institution is described, and its characteristics are included. Data on clinical presentation, type of adrenal anomaly, location, anatomopathological and immune-histotype characteristics were collected. Results: We identified 888 manuscripts. Among these 29 were included in this systematic review. Overall, 39 patients with renal adrenal fusion or adrenal ectopia were considered. In most cases, the diagnosis was made incidentally, or following investigation for flank pain, abdominal pain, or endocrinological disorders. CT scan frequently identified a solid vascularized lesion that was difficult to distinguish from renal neoplasm. Adrenal fusion was mostly located at the level of the upper pole. Adrenal rest was found in the renal parenchyma, renal hilum, or retroperitoneum in close proximity to the renal peduncle. Often these ectopic adrenal tissue lesions follow a benign behavior and can be classified as functioning or non-functioning adenomas. Rarely, they may experience neoplastic degeneration. The most frequently positive markers were inhibin, vimentin, melan-A, synaptophysin and anti-p450 scc. Conclusions: Ectopic adrenal tissue in the kidney is a rare event with specific clinical characteristics that need to be identified in order to arrive at a correct diagnosis and carry out appropriate treatment management.
Collapse
|
9
|
Sato S, Imachi H, Kobayashi T, Fukunaga K, Lyu J, Dong T, Yoshioka Y, Saheki T, Fukata Y, Ban N, Urushihara K, Kadota K, Murao K. Ectopic Cortisol-producing Adrenocortical Adenoma Detected by 131I-6β-iodomethyl-norcholesterol Scintigraphy. Intern Med 2020; 59:1731-1734. [PMID: 32238722 PMCID: PMC7434542 DOI: 10.2169/internalmedicine.4180-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 50-year-old man was referred to our department for overt Cushing's syndrome (CS). His plasma cortisol concentrations were 314 μg/L, and his urinary cortisol concentrations were 431 μg/day. The plasma adrenocorticotropic hormone (ACTH) concentration was below the detectable limit. Computed tomography revealed atrophy of both adrenal glands and the presence of a left pararenal tumor. 131I-6β-iodomethyl-norcholesterol scintigraphy showed an intense uptake by the left pararenal tumor. These findings suggested that the left pararenal tumor was ectopic cortisol-producing adrenocortical adenoma. This case serves as a reminder that 131I-6β-iodomethyl-norcholesterol scintigraphy is an effective method for diagnosing ACTH-independent CS in which no adrenal tumor has been found.
Collapse
Affiliation(s)
- Seisuke Sato
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Hitomi Imachi
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Toshihiro Kobayashi
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Kensaku Fukunaga
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Jingya Lyu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Tao Dong
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Yuuki Yoshioka
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Takanobu Saheki
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Youko Fukata
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Natsuki Ban
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Kurumi Urushihara
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| | - Kyuuichi Kadota
- Department of Pathology, Faculty of Medicine, Kagawa University, Japan
| | - Koji Murao
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, Japan
| |
Collapse
|
10
|
Ashikari D, Tawara S, Sato K, Mochida J, Masuda S, Mukai K, Turcu A, Nishimoto K, Yamaguchi K, Takahashi S. Ectopic adrenal adenoma causing gross hematuria: Steroidogenic enzyme profiling and literature review. IJU Case Rep 2019; 2:158-161. [PMID: 32743400 PMCID: PMC7292187 DOI: 10.1002/iju5.12068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/11/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Aberrant cortical adrenal tissues are not generally identified in adults. Herein, we present a very rare case of an ectopic adrenal tumor located in the renal hilum that caused gross hematuria. Case presentation A 33‐year‐old man suddenly presented with asymptomatic gross hematuria. Abdominal computed tomography revealed a 35‐mm mass in the left renal hilum encroaching the renal vein. Following the surgical removal with frozen section of the mass, his gross hematuria immediately improved. Pathological analysis of the specimen revealed the features adrenal adenoma. Immunohistochemical staining for key steroidogenic enzymes confirmed the adrenocortical origin without excessive hormone production. Conclusion This is the first case of an ectopic adrenocortical adenoma in the renal hilum that caused gross hematuria without hormonal symptoms.
Collapse
Affiliation(s)
- Daisaku Ashikari
- Department of Urology Nihon University School of Medicine Tokyo Japan
| | - So Tawara
- Department of Urology Nihon University School of Medicine Tokyo Japan
| | - Katsuhiko Sato
- Department of Urology Nihon University School of Medicine Tokyo Japan
| | - Junichi Mochida
- Department of Urology Nihon University School of Medicine Tokyo Japan
| | - Shinobu Masuda
- Department of Pathology Nihon University School of Medicine Tokyo Japan
| | - Kuniaki Mukai
- Department of Biochemistry Keio University School of Medicine Tokyo Japan.,Medical Education Center Keio University School of Medicine Tokyo Japan
| | - Adina Turcu
- Department of Endocrinology University of Michigan Ann Arbor Michigan USA
| | - Koshiro Nishimoto
- Department of Biochemistry Keio University School of Medicine Tokyo Japan.,Department of Urology Tachikawa Hospital Tokyo Japan.,International Medical Center-Comprehensive Cancer Center Saitama Medical University Saitama Japan
| | - Kenya Yamaguchi
- Department of Urology Nihon University School of Medicine Tokyo Japan
| | - Satoru Takahashi
- Department of Urology Nihon University School of Medicine Tokyo Japan
| |
Collapse
|
11
|
Lu D, Yu N, Ma X, Zhang J, Guo X. An ectopic adrenocortical adenoma in renal hilum presenting with Cushing's syndrome: A case report and literature review. Medicine (Baltimore) 2018; 97:e13322. [PMID: 30557981 PMCID: PMC6319990 DOI: 10.1097/md.0000000000013322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
RATIONALE Ectopic adrenal tissue is the adrenal rests along the path from gonads to adrenal glands during embryogenesis. Ectopic adrenocortical adenoma is a rare disease represented with over-production of cortisol by the ectopic adrenocortical tissue. PATIENT CONCERNS An 18-year-old Chinese female patient was presented with weight-gain for 6 months. She had elevated plasma cortisol and a solitary mass was revealed using computed tomography scan in the left renal hilum. DIAGNOSIS The tumor was removed and the immunohistochemical profile indicated an ectopic adrenocortical adenoma. INTERVENTIONS After the tumor was removed, the patient was under glucocorticoid replacement therapy in 6-month. OUTCOMES During 6-month of follow-up, the patient showed no signs of tumor recurrence. LESSONS Ectopic adrenocortical adenoma is difficult to diagnose due to its low incidence, and the ectopic rests in renal hilum could be misdiagnosed as renal cell carcinoma. This case reminds clinicians to be aware of ectopic site in the diagnosis of adrenocorticotropic hormone (ACTH) independent Cushing's syndrome. Immunohistochemical stain may assist in evaluating the origin of the ectopic rests. A certain rate of local recurrence indicated the need of long-term follow-up.
Collapse
|
12
|
Hernández C, Ulloa J, Pizza S, Moreno M. Adenoma adrenocortical ectópico parahiliar renal, en paciente con síndrome de Cushing independiente de ACTH. Abordaje laparoscópico. Reporte de caso y revisión de la literatura. UROLOGÍA COLOMBIANA 2018. [DOI: 10.1016/j.uroco.2017.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objetivos El adenoma adrenocortical ectópico es el producto de la transformación de tejido adrenal ectópico embriológico en adenoma funcionante. Su asociación con síndrome de Cushing corresponde a menos del 2% de los casos. El presente es el noveno caso reportado en la literatura, por lo tanto se pretende recalcar la manera de realizar un adecuado abordaje diagnóstico multidisciplinario logrando el enfoque quirúrgico que permite el mejor tratamiento.
Materiales y métodos Búsqueda en bases de datos Pubmed, Lilacs, Embase. Revisión de la historia clínica y seguimiento postoperatorio.
Resultados Paciente femenina de 28 años quien presentó un aborto en primer trimestre de embarazo, asociado a hipertensión arterial, facies de luna llena y obesidad centrípeta. Se encuentra masa pararrenal izquierda. Se realiza abordaje laparoscópico para la resección de la misma, con patología que informa adenoma cortical adrenal. Resolución de sintomatología después del procedimiento.
Conclusiones Es un caso de baja frecuencia, donde es importante identificar la sintomatología temprana, así como realizar un abordaje multidisciplinario con el fin de realizar un correcto abordaje diagnóstico y terapéutico.
Collapse
Affiliation(s)
| | - José Ulloa
- Urólogo, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sara Pizza
- Médica y cirujana, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Mauricio Moreno
- Urólogo, Unidad de Urología, Hospital de la Policía, Bogotá, Colombia
| |
Collapse
|
13
|
Tingi E, Ogah J. Ectopic adrenal rest cells of the fallopian tube: a case report and review of the literature. J OBSTET GYNAECOL 2018; 38:578-579. [PMID: 29385841 DOI: 10.1080/01443615.2017.1379063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Joe Ogah
- a Furness General Hospital , Barrow in Furness , UK
| |
Collapse
|