CASE PRESENTATION<br />Dr.YazeedOwiwi<br />Pediatric Surgery Department<br />FCPS-II Trainee, PGR-III<br />
CASE HISTORY<br />20th Dec, 2010  <br />Saira<br />                      -  20 months old girl <br />Hirsutism      -<br /...
BMI<br />			HEIGHT  76 CM<br />	WIGHT 12.5 KG<br />
Investigation<br />Blood CP *<br />* S/biochemistry<br />BSR   monitoring *<br />* Testosteron level<br /><ul><li>* Serum ...
Dexamethasonesuppresion test*   </li></ul> 24 hour urinary cortisol*<br />* Plasma ACTH level<br />* Ultrasound abdomen<br...
Results<br />Blood cp<br />Serum electrolyte<br />WNLUrea/Creatinine<br />BSR<br />LFTs<br />Testosteron level       11.8 ...
Serum Cortisol<br />             8:00 am        14 ug/dl<br />             8:00 pm        29 ug/dl <br />Normal  2.3 -19.9...
Plasma ACTH                            22.20 pg/dl<br />                                                                 (...
Ultrasound Abdomen <br />Right supra renal mass with evidance of focal calcification<br />
CT scan Abdomen<br />Well defined lobulated soft tissue mass lesion --  approximatly         cm in right supra renal regio...
Further Investigation<br />24 hr urinary VMA            4.2 mg/24 hours<br />                                             ...
Surgery were planned…..<br />
Pre-operative manegment<br />normal* Blood pressure.<br />* Serum electrolyte, no hypokalemia<br />* BSR, 89 mg/dl       n...
Peri-operative manegment<br />* N/g tube placed. <br />* 2 wide bore cannula placed.  <br />* Prophylactice antibiotic giv...
Open Right Adrenalectomy<br />
Post-operative manegment<br />--Tissue biopsy sent for histopathology.<br />--N/G tube removed 1st post-op day.<br />--Inj...
Histopathology<br />Adrenal Cortical Neoplasm<br />    There is marked pleomorphism and scattered  mitosis. However to est...
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Adrenocortical carcinoma

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Adrenocortical carcinoma

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Adrenocortical carcinoma

  1. 1. CASE PRESENTATION<br />Dr.YazeedOwiwi<br />Pediatric Surgery Department<br />FCPS-II Trainee, PGR-III<br />
  2. 2. CASE HISTORY<br />20th Dec, 2010 <br />Saira<br /> - 20 months old girl <br />Hirsutism -<br /> Moon face- <br />Central obesity -<br />BMI 21.6 >95thcentile - <br />
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  7. 7. BMI<br /> HEIGHT 76 CM<br /> WIGHT 12.5 KG<br />
  8. 8. Investigation<br />Blood CP *<br />* S/biochemistry<br />BSR monitoring *<br />* Testosteron level<br /><ul><li>* Serum cortisol levels
  9. 9. Dexamethasonesuppresion test* </li></ul> 24 hour urinary cortisol*<br />* Plasma ACTH level<br />* Ultrasound abdomen<br />* CT Abdomen<br />
  10. 10. Results<br />Blood cp<br />Serum electrolyte<br />WNLUrea/Creatinine<br />BSR<br />LFTs<br />Testosteron level 11.8 nmol/L<br /> (female: 0.3-3.0 nmol/L)<br />
  11. 11. Serum Cortisol<br /> 8:00 am 14 ug/dl<br /> 8:00 pm 29 ug/dl <br />Normal 2.3 -19.9 ug/dl ) )<br />Dexamethason Suppressive Test -ve<br />
  12. 12. Plasma ACTH 22.20 pg/dl<br /> (Normal value 10-100 pg/dl)<br />24 Hrs urinary Cortisol 27.9 ug/dl<br />( (Normal value 43-176 ug/dl<br />
  13. 13. Ultrasound Abdomen <br />Right supra renal mass with evidance of focal calcification<br />
  14. 14. CT scan Abdomen<br />Well defined lobulated soft tissue mass lesion -- approximatly cm in right supra renal region.<br />--Its arrising from right adrenal gland<br />--Multiple calcific foci.<br />--Suggestive of Neuroblastoma.<br />
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  17. 17. Further Investigation<br />24 hr urinary VMA 4.2 mg/24 hours<br /> (Normal value < 13.6)<br />
  18. 18. Surgery were planned…..<br />
  19. 19. Pre-operative manegment<br />normal* Blood pressure.<br />* Serum electrolyte, no hypokalemia<br />* BSR, 89 mg/dl normal<br />* Pt shifted to PICU prior to surgery.<br />* 2 pints of blood crossed matched and prepared.<br />* Pt NPO at 3 am on day of operation. <br />
  20. 20. Peri-operative manegment<br />* N/g tube placed. <br />* 2 wide bore cannula placed. <br />* Prophylactice antibiotic given. <br />* Inj. Hydrocotisone 25mg given followed by 25mg/24 hour in infusion form.<br />* Injhydralazin on hand. <br />
  21. 21. Open Right Adrenalectomy<br />
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  43. 43. Post-operative manegment<br />--Tissue biopsy sent for histopathology.<br />--N/G tube removed 1st post-op day.<br />--Inj. Hydrocortisone given in tapering form.<br />--Switch to oral coticosteroid 7th post-op day.<br />--Stitch removed at 10th post op day.<br />
  44. 44. Histopathology<br />Adrenal Cortical Neoplasm<br /> There is marked pleomorphism and scattered mitosis. However to establish malignant nature of the lesion, the evidence of metastasis is mandatory !<br />
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  50. 50. THANK YOU<br />

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