-
Views
-
Cite
Cite
Rossella Libé, Frédérique Tissier, Marie Bienvenu, Lionel Groussin, Sylvie Joannidis, Chantal Hignette, Bertrand Dousset, Paul Legmann, Marc Faraggi, Bruno Richard, Xavier Bertagna, Florence Tenenbaum, Adrenocortical Tumor with Two Distinct Elements Revealed by Combined 18F-Fluorodeoxyglucose Positron Emission Tomography and 131I Nor-Cholesterol Scintigraphy, The Journal of Clinical Endocrinology & Metabolism, Volume 94, Issue 10, 1 October 2009, Pages 3631–3632, https://doi.org/10.1210/jc.2009-1025
Close - Share Icon Share
Extract
A 67-yr-old woman with an adrenal incidentaloma was diagnosed with ACTH-independent Cushing’s syndrome (urinary free cortisol = 286 μg/24 h; normal range, 25–90). She also had high plasma deoxycorticosterone, 11-deoxycortisol, and testosterone levels—findings suggestive of an adrenocortical carcinoma.
Computed tomography imaging showed a heterogeneous right adrenal mass (38 × 44 mm) with two components that had high and low attenuation densities for the upper and lower aspects, respectively (Fig. 1A).
Positron emission tomography (PET) scanning with 18F-fluorodeoxyglucose (FDG) and a [6β-131I]iodomethyl-19 nor-cholesterol (NP-59) scintigraphy showed a mirror image of the two components, suggesting a malignant upper tumor and a benign lower tumor, both of adrenocortical origin (Fig. 1, B and C).
Pathology confirmed the anticipated natures of the two different components: the upper one was an adrenocortical carcinoma (Weiss score = 7), and the lower one was an adrenocortical adenoma (Weiss score = 2) (Fig. 2).
Previous cases have documented the presence of a double component in adrenocortical tumors (1, 2), suggesting a multistep adrenal tumorigenesis. Recently, we showed that 18F-FDG PET helped distinguish between benign and malignant adrenal lesions (3).
