Diagnostic evaluation of a patient with suspected Cushing’s Syndrome and hyperandrogenism: metabolic and clinical aspects for a correct differential diagnosis

85-89 Adrenal tumors are tumors in which the oncological aspect (adenoma or carcinoma) can be associated with an endocrinological component responsible for a specific clinical syndrome (Cushing’s Syndrome, Conn’s disease or androgenic hypersecretion). We describe the diagnostic evaluation of a 65 years old woman with hirsutism and high serum level of androgens. The evaluation of this case needed the determination of serum adrenal androgens, abdominal ultrasonography, computerized tomography (CT) before and after contrast, a total body positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) and the evaluation of different tumoral markers. The CT evidenced the presence of a large mass (9X6 cm) in the right adrenal. This mass had not a clear distinction from the I, VI and VII hepatic segment, infiltrated the inferior cava and the renal vein of the same side; this lesion presented an important and disomogeneous uptake of constrast. PET confirmed a disomogeneous uptake of FDG. Hormonal evaluation showed very high level of testosterone, androstenedione, dehydroepiandrosterone sulfate and free urinary cortisol. The patient underwent adrenalectomy and ipslateral nephrectomy. The histological examination con- firmed the suspicion of adrenal carcinoma. The appearance of hirsutism, toghether with high levels of androgens can be considered a marker of an androgen-secreting tumor. For this reason, a correct diagnostic evaluation has to investigate the adrenal function with the aim of a precocious diagnosis and treatment of this tumor sometimes highly aggressive.