Sunitinib Therapy and Adrenal Cortical Adenoma: A Case Report and Discussion Regarding Use of Receptor Tyrosine Kinase Inhibitors in Adrenal Tumours.
Dr J Williams (SpR in Oncology), Mr T Christmas (Consultant Urologist), Dr S Hazell (Consultant Pathologist) & Dr P Savage (Consultant Medical Oncologist).
We report the case of a 72 year old, female Jehovah’s Witness, with ipsilateral, biopsy confirmed, clear cell renal cancer and adrenal cortical adenoma and a left lung lesion, who received neoadjuvent Sunitinib therapy to reduce her tumour bulk and therefore intraoperative blood loss. Radiologically, her disease responded well to treatment and she subsequently underwent a radical nephrectomy and adrenalectomy. Of note, surgical histology demonstrated necrosis and fibrosis in the renal tumour and multiple areas of ischaemic necrosis within the adrenal adenoma. This case illustrates the difficulties regarding management of radiologically detected adrenal lesions and to our knowledge, is the first report of activity of Sunitinib in an adrenal cortical adenoma. The use of Receptor Tyrosine Kinase Inhibitors in patients with hypersecretory adenomas (Conn’s and Cushing’s syndrome), adrenocortico carcinomas and pheochromocytomas is discussed.