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CASE HISTORY
20th Dec, 2010
Saira
- 20 months old girl
Hirsutism -
Moon face -
Central obesity-
BMI 21.6 >95th centile -
InvestigationBlood CP*
*S/biochemistry BSR monitoring*
*Testosteron level• *Serum cortisol levels
• Dexamethasone suppresion test *
24 hour urinary cortisol*
*Plasma ACTH level *Ultrasound abdomen
*CT Abdomen
Results
Blood cpSerum electrolyte
WNL Urea/Creatinine
BSRLFTs
Testosteron level 11.8 nmol/L ( female: 0.3-3.0 nmol/L )
Serum Cortisol 8:00 am 14 ug/dl 8:00 pm 29 ug/dl
Normal 2.3 -19.9 ug/dl ) )
Dexamethason Suppressive Test -ve
Plasma ACTH 22.20 pg/dl( Normal value 10-100
pg/dl )
24 Hrs urinary Cortisol 27.9 ug/dl( ( Normal value 43-
176 ug/dl
CT scan Abdomen
Well defined lobulated soft tissue mass lesion -- approximatly cm in right supra renal region.
--Its arrising from right adrenal gland--Multiple calcific foci.
--Suggestive of Neuroblastoma.
Pre-operative manegment
normal * Blood pressure.
* Serum electrolyte, no hypokalemia *BSR, 89 mg/dl normal
*Pt shifted to PICU prior to surgery.
*2 pints of blood crossed matched and prepared.
*Pt NPO at 3 am on day of operation .
Peri-operative manegment
*N/g tube placed .
* 2 wide bore cannula placed .
*Prophylactice antibiotic given .
*Inj. Hydrocotisone 25mg given followed by 25mg/24 hour in infusion form.
*Inj hydralazin on hand .
Post-operative manegment
--Tissue biopsy sent for histopathology.
--N/G tube removed 1st post-op day.
--Inj. Hydrocortisone given in tapering form.
--Switch to oral coticosteroid 7th post-op day.
--Stitch removed at 10th post op day.
Histopathology
Adrenal Cortical Neoplasm There is marked pleomorphism and
scattered mitosis. However to establish malignant nature of the lesion, the evidence of metastasis is mandatory!