Journal of Clinical Case Reports

Functional Adrenocortical Oncocytoma Presenting with Hyperandrogenism and Seizures

Abstract

Valentinas Matulevicius, Catalina Poiana, Rytas Ostrauskas, Ilona Banisauskaite, Indre Matuleviciute, Justina Jureviciute, Vaidotas Urbonavicius, Rasa Verkauskiene and Lina Ciaplinskiene

A 38-year-old woman was referred to an Endocrinologist with sudden onset of a variety of clinical symptomsepileptic seizures, amenorrhea, weight gain, hirsutism and sexual dysfunction. Her physical examination and biochemical investigations, including blood sugar were normal. Blood pressure was 110/80 mmHg. A right adrenal tumor was detected on ultrasonography and computed tomography. Blood levels of dehydroepiandrosteronesulphate, testosterone and aldosterone were increased 2.2, 7.6 and 1.6 times higher than maximal normal values respectively. The aldosterone/renin ratio was 176. The laparoscopic excised tumors of the right adrenal gland weighed 137 g and was red-yellowish-brown with the intact capsule. Histology of the tumor showed round, oval or polygonal cells with abundant granular eosinophilic cytoplasm. Nuclei were oval, basophilic and with nucleoli. Focally pleomorphic nuclei were noticed. The cells formed nests and trabeculae. Histological picture was suggestive for oncocytoma. Immunohistochemical investigations showed: alpha-inhibin-diffusely positive in tumor cells, synaptophysin-positive in zones of tumor cells, melan A-diffusely positive in tumor cells, Ki-67-positive in 10% of tumor cells, Chromograninnegative in tumor cells but positive in medullary zone. After the surgery, almost all the hormones returned to normal and were maintained at this level for 12 months post operation. An exception was aldosterone, which was increased, but without symptoms of hyperaldosteronism. The patient did not report any seizures after the surgical treatment. Sexual function regained 6-12 months post-surgery.