Rao Abhinav K, Nguyen Trang Minh Thi, Magri Jenna Brennan, Mathews Joseph Wolfgang
Trident Internal Medicine, Trident Medical Center, North Charleston, SC 29406, USA.
Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
JCEM Case Rep. 2024 Oct 7;2(10):luae151. doi: 10.1210/jcemcr/luae151. eCollection 2024 Oct.
Adrenal adenomas are benign tumors of the adrenal cortex that may secrete excess hormones, such as cortisol. They are most commonly discovered during imaging studies for unrelated problems. Lipomatous metaplasia is a rare degenerative change in adrenal adenomas, characterized by the presence of adipose tissue and hematopoietic elements within the tumor. In this report, we present a case of an adrenal adenoma with lipomatous metaplasia in a patient with hypertension, hyperlipidemia, and type II diabetes mellitus. The discovery of this adrenal mass was prompted by an evaluation of the patient's progressive hirsutism. The tumor was found to be secreting cortisol, leading to Cushing syndrome. The patient subsequently underwent surgical resection of the mass after being treated with mifepristone. The histopathological examination confirmed it to be an adrenal cortical neoplasm with lipomatous metaplasia, characterized by uncertain malignant potential. The patient did well postoperatively. Three months after left adrenalectomy, the patient's hirsutism, A1c, and hypertension improved, allowing a reduction in antihypertensives. Her body mass index stabilized, her triglyceride decreased, and her dehydroepiandrosterone sulfate level normalized. She continued to do well at follow-up visits. Overall, this was a rare case of a functioning adrenal adenoma with lipomatous metaplasia, presenting both diagnostic and therapeutic challenges.
肾上腺腺瘤是肾上腺皮质的良性肿瘤，可能分泌过量激素，如皮质醇。它们最常在因无关问题进行的影像学检查中被发现。脂肪化生是肾上腺腺瘤中一种罕见的退行性改变，其特征是肿瘤内存在脂肪组织和造血成分。在本报告中，我们介绍了一例患有高血压、高脂血症和II型糖尿病的患者，其肾上腺腺瘤伴有脂肪化生。该肾上腺肿物的发现是由于对患者进行性多毛症的评估。发现该肿瘤分泌皮质醇，导致库欣综合征。患者在接受米非司酮治疗后，随后接受了肿物的手术切除。组织病理学检查证实其为伴有脂肪化生的肾上腺皮质肿瘤，其恶性潜能不确定。患者术后恢复良好。左肾上腺切除术后三个月，患者的多毛症、糖化血红蛋白和高血压有所改善，降压药得以减量。她的体重指数稳定，甘油三酯下降，硫酸脱氢表雄酮水平恢复正常。随访时她继续情况良好。总体而言，这是一例罕见的伴有脂肪化生的功能性肾上腺腺瘤病例，带来了诊断和治疗方面的挑战。
