Endocrine Abstracts

Adrenocortical carcinomas are rare malignancies (incidence 1–2/one million). They present in a variety of ways and carry a poor prognosis. Prompt diagnosis and early intervention offers better outcome.

We describe 5 cases of adrenocortical carcinoma to help identify and improve delays in their pathway of care. Five patients (four females and one male), age range 38–76 years, presented between September 2011 and April 2013. Three patients referred by GP had suggestive symptoms for previous 3–6 months, with a delay in diagnosis. Three presented with mass symptoms and two with secretory symptoms. All tumors were stages III–IV at diagnosis (adrenal size ranged from 8 to 20 cm). First MDT waiting time was < 1 week to 2 months (post-operatively). The patient who was unsuitable for resection had a decision about complex surgery 10 days after referral to tertiary MDT – an anguished wait as an inpatient. A further patient waited 3 months for a joint procedure at a tertiary cancer centre. All patients had Mitotane prescribed immediately after histological confirmation and presence of metastases, except one patient this was delayed until she presented 2 months later with progressive disease. Only one patient managed therapeutic levels (due to side effects). All patients with progressive disease were offered chemotherapy and were either too unwell (two patients) or declined (two patients).

Patients present late with adrenal cancer. The longest delay was in initial diagnosis due to the rarity and complexity of symptoms not being recognised in primary care. However there were other delays in biochemical work up, discussion through MDT, surgical treatment and post-operative mitotane initiation. All patients had care involving more than one centre, from specialist centres to district general hospitals. Logistics of diagnosis, investigation and treatment across primary, secondary and tertiary centres can be improved for optimal care.