腎上腺皮質癌合併下腔靜脈及右心房腫瘤栓塞—病例報告

劉惠瑛¹、黃鏘綺²

¹高雄長庚泌尿科

²高雄長庚腎臟科

Adrenal Cortical Carcinoma with IVC/RA Thrombus—Case report

Hui-Ying Liu¹, Chiang-Chi Huang²

¹Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

²Department of Nephrology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

Abstract

A 50-year-old woman with hypertension presented to the emergency departement with general weakness for 1 week. On physical examination, she had moon face, abdominal obesity and thin extremities. The laboratory studies showed severe hypokalemia 1.6 milliequivalent per liter (reference range, 3.5 to 5.0). Subsequent workup revealed metabolic alkalosis, hyperglycemia, elevated level of cortisol 40.18 microgram per deciliter (reference range, 7.2 to 63.3) and suppressed level of adrenocorticotropic hormone (ACTH) < 1.5  picogram per milliliter (reference range, 7.2 to 63.3). The hypercortisolism is consistent with the diagnosis of Cushing syndrome. Contrast-enhanced computed tomography of the abdomen revealed a large right adrenal mass with a diameter of 6.0 x 8.8 x 10.8 cm accompanied with tumor thrombus extending into the right atrium (RA) through inferior vena cava (IVC). At meantime, multiple liver hemangiomas were accidentally found. She underwent laparotomy surgery of right adrenalectomy with IVC and RA thrombus resection. The pathological examination revealed the mass to be an adrenocortical carcinoma. One month follow-up, the level of cortisol was within normal limit. She was discharged and referred to oncology outpatient department for further treatment.