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Adrenal Mass Diagnosis and Surgery Case Study

Mrs. Hoda, a 32-year-old female, presented with symptoms including fatigue, weight gain, facial changes, and irregular menstrual periods, leading to a diagnosis of Cushing's syndrome. Investigations revealed high cortisol levels and a right adrenal mass, prompting a laparoscopic right adrenalectomy. Post-surgery, she received steroid supplementation to manage her symptoms and support recovery.

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Amera Kolep
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2 views2 pages

Adrenal Mass Diagnosis and Surgery Case Study

Mrs. Hoda, a 32-year-old female, presented with symptoms including fatigue, weight gain, facial changes, and irregular menstrual periods, leading to a diagnosis of Cushing's syndrome. Investigations revealed high cortisol levels and a right adrenal mass, prompting a laparoscopic right adrenalectomy. Post-surgery, she received steroid supplementation to manage her symptoms and support recovery.

Uploaded by

Amera Kolep
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Problem 3

Mrs. Hoda 32-year-old female presented to the outpatient clinic because of


increasing fatigue, weakness, and lethargy. She also gained 14 kg over the last 5
months with central distribution of weight gain and neck obesity, gradual
rounding of her face over the past 6 months, Facial hair on her chin and upper lip
and Acne (6-8 months ago).

Her history revealed skin bruising after minor trauma, difficulty in climbing
stairs, severe back pain, irregular menstrual period (last 4-5 months), craving to
sweets with increased urine flow, Depressed mood with no past history of any
drug intake.

Clinical Examination showed:

Vital signs: all normal except collection of subcutaneous fat at the base of her
neck, BP was 150/90.

Abdominal Examination: Truncal obesity, Purpureal abdominal striae.

Lower limb: thin weak thigh muscles. Back: tenderness over L4+5.

Investigations were ordered that showed:

Dipstick urinalysis: presence of glucose.

Full blood count: all normal except WBC 12.000/cmm.

Blood chemistry: all normal except rise of random blood Glucose (210 mg/dl).
Hormonal assays: high serum cortisol am specimen (45.0μg/dL). The
circadian rhythm of plasma cortisone is lost. Elevated urinary free-cortisol levels
were noted (1027 and 958μg/day respectively), and the ACTH level was
undetectable (<5.0pg/mL) – high urinary cortisol level of 486μg/day (reference
range: 20– 80μg/day), mild rise of Testosterone. Prolactin and thyroid Function
were all normal.

X-ray spine revealed: compression fracture between L4-L5 and Osteoporosis.


Adrenal contrast computed tomography (CT) revealed a right side supra renal
mass (3cmx4cm).

Patient preferred to have surgery and not adrenocortical antagonists, so the


patient underwent laparoscopic right adrenalectomy. The pathology report was
ordered. Postoperative steroid supplementation was initiated for her fatigue and
low systolic blood, persistent low blood sugar with expectation of regain function
of the left one.

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