The goal of this paper is to emphasise the importance of clinicopathological correlation in the diagnosis of a rare non-functional adrenal tumour in HIV patients with Pseudo-syndrome. Cushing's
A radiological diagnosis of adrenocortical cancer was made due to the presence of cortisol excess in the background of adrenal tumour. Histology revealed an oncocytic tumour with unknown malignant potential and elevated cortisol levels in the blood, which remained elevated even after the tumour was removed. These tumours should ideally be non-functional and unrelated to an increase in cortisol levels. However, the histology diagnoses did not match the biochemical results. After a thorough review of the patient's medical history, it was discovered that he was a known HIV patient on antiretroviral medication. Finally, taking everything into account, it was determined that the hypercortisolemia was caused by antiretroviral drug therapy and that the tumour was a rare, non-functional incidental tumour.
The takeaway message was that without sufficient clinical information of the patient's medication regimen and HIV status, the diagnosis of a non-functional adrenal tumour in the context of hypercortisolemia characteristics would have been suspect.
Introduction: We present a 70-year-old HIV-positive man with a non-functional oncocytic adrenal tumour with unknown malignant potential and Pseudo-syndrome Cushing's manifestations.
The majority of the information was gathered through institutional clinical reports and radiological findings. These were collated and compared to existing case reports on HIV-related adrenal symptoms.
Results: HIV patients have a variety of endocrine symptoms, including problems in the adrenal, testicular, pituitary, pancreatic, and thyroid glands. Adrenal insufficiency caused by opportunistic infections or tumours such as Kaposi's sarcoma or Non-lymphoma Hodgkin's are the most common adrenal disorders (NHL).
In HIV individuals, no incidental adrenal oncocytic tumour with questionable malignant potential has been observed.
Conclusion: Pseudo-syndrome Cushing's is a relatively unusual tumour identified in HIV patients.Author(S) Details
Zaibun Nisa
Department of Histopathology, Queen’s Hospital, Romford, London.
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