A case of bilateral adrenal incidentalomas in a hypertensive patient with familial adenomatous polyposis. Double Jeopardy?
TS Han, T Kurzawinski, DC Patel, GS Conway,
University College Hospital.
Case: A 39 year old patient with familial adenomatous polyposis (FAP) was scheduled to undergo a Whipple’s procedure for associated intra-abdominal disease. At this time radiological review of a computerised tomography (CT) scan demonstrated additional bilateral adrenal masses. The right adrenal measured 3.4x1.4x2.0cm and there was a 1 cm nodule in the left adrenal gland. He was known to be hypertensive requiring four therapeutic agents.
Provisional investigation did not reveal evidence of either cortisol or catecholamine excess. Plasma Aldosterone concentration was elevated at 1481 pmol/l with a aldosterone:renin ratio of 1664. Further investigation has since been undertaken.
Discussion: The prevalence of adrenal incidentaloma in patients with FAP seems to be greater than the normal population. However, functional adrenal tumours have been rarely described. Approach to investigation and management will be discussed.
It is not certain whether there is a genetic basis to developing adrenal tumours related to the underlying condition and if these invariably behave like sporadic tumours. There have been few systematic studies to examine the true incidence and natural history of adrenal tumours among patients with FAP.