A 35-year-old farmer sustains chest injuries following an accident at the farm for which he is subjected to CT imaging of thorax and abdomen which reveals bilateral adrenal mass, measuring 4 cm × 3 cm × 4 cm, homogeneous, smooth walled, isodense with liver and well enhancing on contrast administration. He is asymptomatic prior to the accident. Examination reveals a normally built male, normal vitals, no postural drop in blood pressure. No obvious hyperpigmentation. Biochemical evaluation are all normal except a serum sodium levels of 129 mEq/L. TSH, total T4 levels are normal. At 8 am cortisol is 5 mg/dL with a corresponding ACTH of 100 pg/mL. A synacthen stimulation test with 250 mg given IV is done and 60 min cortisol of 13 mg/dL is obtained. A diagnosis of Addison’s disease is made. Chest X-ray and Mantoux test are normal. 24-hour urine collection for metanephrines is normal. A CT-guided FNAC is performed which reveals 2–4 μm oval, budding yeast forms with a probable diagnosis of histoplasmosis. ELISA for human immunodeficiency virus is negative. Patient is started on hydrocortisone 15 mg/day in two split doses. Patient is given intravenous amphotericin B for two weeks followed by oral itraconazole for one year.
What is the role of fine needle biopsy ?
Medicine
Fine-needle biopsy (FNB) is currently not recommended for the routine work-up of AI. Often, clinical, hormonal and radiologic findings can effectively direct treatment. Infectious diseases form an important reason for FNA, especially in our country as illustrated in case 2. It is also associated with relatively rare, but significant complications; pheochromocytoma must always be ruled out before biopsy is undertaken to avoid potentially life-threatening hemorrhage and hypertensive crisis.
need an explanation for this answer? contact us directly to get an explanation for this answer