Endocrine Abstracts

Adrenocortical carcinoma (ACC) is a rare neoplasm with poor prognosis. Patients can present signs of hormone excess: virilisation, Cusging’s syndrome or only enlarged abdominal mass. Incidentally ACC can be also detected in the ultrasonography. Some of ‘non-hypersecretory’ ACCs can produce non-bioactive hormones steroid precursors or not very big amount of them and sometimes patients present subclinical Cushing’s symptoms. Surgery and adjuvant radiotherapy and chemotherapy with Mitotane is the treatment of choice. The aim of the study was to analyse clinical features, hormonal test results and prognosis in patients with secreting and non- secreting adrenal cancers.

Patients: The study group included 49 patients: 11 men and 38 women median age 68 year. Clinical examination, the imaging studies and hormonal assays were performed. Forty four patients underwent surgical treatment, five of them were qualified only to palliative treatment. Chemotherapy with Lysodren was administered in 39 patients.

Results: Secretory tumors were diagnosed in 23 cases and non-secretory in 26 cases. Twenty five patients are still alive and the median time of observation is 60 months (min 13 months, max 312 months). Nineteen patients of this group were classified as the 1-st or 2-nd stage and 14 were diagnosed as non-secretory tumors. Due to ACC progress 22 patients died during the time of observation, and two patient died due to surgical complications. The median time of observation in this group was 15,5 months (min. 1 month an max 192 months). In this group 12 patients were classified as 3-rd or 4-th stage and 12 patients were diagnosed as secretory tumors.

Conclusion: The poor prognostic factors in ACC are: size of tumor, presence of local and distant metastases and hormonal activity. Chemotherapy with Lysodren prolong life of patients, but is less effective in advanced disease.