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Possible active adrenal tumour

Hello, I'm a 56 year old male. Four years ago I had papillary thyroid cancer with local spread to lymph nodes. It was treated with a total thyroidectomy and removal of affected nodes and subsequent radio iodine treatment. There has been no recurrence. In December of 2019 a nodule on one of my adrenal glands showed up on a CT. It was 1.2cm in size. I had some hormonal tests done and there were no abnormal levels. This month my endocrinologist asked for more blood tests, principally thyroid related tests (TSH, T4, thyroglobulin, etc) but also DHEA-S. All tests were normal except for elevated DHEA-S levels. In the past my DHEA-S levels have typically been between 350 and 400ug/dL. The recent reading was 654ug/dL. The endocrinologist asked for the test to be redone. I did the test again yesterday and the level is still high, measuring 684ug/dL.

I now have to wait for the results of a second CT with contrast that I am trying to organise. It may take weeks for the final result as the insurance company takes a very long time to approve more expensive exams. The endocrinologist said I need to wait to see if the nodule has grown in size but did not offer any more information.

I'm wondering what is the likelihood that this nodule is malignant and also what more tests, beyond the imaging, should be done to prove if it is functional, malignant or not?  

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15695260 tn?1549593113
Hello and welcome to the forum. Thank you for your question but we are sorry that you have to ask it.  You are doing the right thing working with your physician who is the absolute best source of answers to your questions.  We know you are particularly worried given your previous cancer diagnosis. Your elevated DHEAS has caught the eye of your physician and they will take appropriate steps to surmise if the tumor is cancerous or not. It can be hard to tell and imaging is really necessary to make that call.  An androgen producing adrenal tumor does not have to be cancer. But since it may, this is important to address. Please note, a benign tumor can also secrete androgens and estrogens in excess. That this would be cancer, please not that this is rare.  However, you need to find out.  https://www.sciencedirect.com/science/article/abs/pii/S0093775410001867

Please let us know when you get your CT scan set up.  It's unfortunate if your insurance company holds this up in any way.  But let us know when you've scheduled it.
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Thank you. I did the CT and received the results just over a week ago. I forwarded the results to my urologist and endocrinologist and both said that the results are good. I have a doubt though, which I'll get to. Since December in 2019, the adrenal nodule grew only 2mm (from 1.1cm to 1.3cm) and has an absolute washout of 81% and relative washout of 72%. All good. What I did not look at the report was in relation to liver nodules. In 2019 a single 6mm nodule was reported as a possible cyst. On this occasion (this month) nodules were mentioned in the plural with the size of 7mm. In this recent CT an additional 20mm "hyper-vascular" and "indeterminate" liver nodule with "no washout" was included in the report. I think I'd been so preoccupied with the adrenal nodule I failed to notice this until now but I wonder why my doctors didn't mention it. I will contact them on Monday. This find is worrying me, I must admit. Could it be that the adrenal nodule is secondary to some other tumour?

A week ago my endocrinologist asked for five more blood tests: DHEA (and not DHEA-S), 17 alpha hydroxyprogesterone, free testosterone, total testosterone and androstenedione. I did these tests last Saturday. So far only the testosterone and the androstenedione results have been released. The testosterone levels are normal and well within the range of my usual levels since 2014. The androstenedione level, which I've not had tested before, was however elevated, 4.68ng/ml (reference range 0.6-3.7).

It sounds like you are receiving thorough care and are a great advocate for yourself. Please let us know all of the results you receive. In men, elevated androstenedione levels can cause an abundance of estrogen.  Sometimes elevation can indicate a small tumor. But all are hard to speculate without full reports. And your doctors are the best source of information. That they are happy with the results but are digging deeper is a good sign that you will uncover anything that needs to be resolved or treated. To be honest, your slight elevation is not a red flag and is normally going to turn out to be idiopathic.  Let us know what all the results are and what your doctor suggests.
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