Endocrine Abstracts

Introduction: Adrenal carcinomas are rare tumor. It has an estimated incidence of ~0.5–2 new cases per million people per year. Just 25% of adults with hormone-secreting adrenal carcinomas present overproduction of both glucocorticoids and androgens. Women develop adrenal carcinomas more often than men.

Objectives: We report a case of 47-year-old female presented with weight gain, generalized weakness and hypertension for the last 6 months. Physical examination revealed central obesity, “moon facies” with facial plethora, facial hirsutism, and acne in the back of the chest, “bison neck”, muscle weakness, hypertension and emotional lability.

Methods: The paraclinical examination showed: hypercholesterolemia, glucose intolerance, ACTH = 3.9 pg/ml (n = 5–65), 2300 h serumcortisol = 13.83 µg/dl, 0800 h serumcortisol = 25.2 µg/dl, urinaryfreecortisol (UFC) = 209.69 µg/24 h (n = 21–111), after 1 mg dexamethasoneovernightsupression – 0800 h serumcortisol = 16.63 µg/dl, testosterone = 1.14 ng/ml (n<0.75), DHEAS, plasma metanephrines and normetanephrines, aldosterone, renin are normal. Computed tomography examination showed left adrenal mass (11.5/7.7 cm) with blooming contour and hepatomegaly with subcapsular nodule on the right side.

Results: The left adrenal tumor was surgically excised by laparoscopic approach. Postoperatively the patient received hydrocortisone hemisuccinate substitution treatment with a favorable progression. Histopathological examination: adrenal carcinoma fully resected. Score Weiss = 6 points (high nuclear grade, mitotic rate 18/50 HPF, atypical mitosis, necrosis, sinusoidal invasion, capsular invasion). ENSAT stage II (T2N0M0). Postoperatively patient had secondary adrenal failure and received glucocorticoid substitution therapy; she loosed 9 kg, blood pressure and glucose levels returned to normal with no need for antihypertensive medication. She received local radiotherapy complicated with hepatic cytolysis and cholestasis (AST, ALT, GGT). 1 year postoperatively, computed tomography showed space replacing liver formation and normal right adrenal gland. She will start adrenolytic therapy with mitotane.

Conclusions: In adrenal carcinoma the prognosis was poor, but the use of adjuvant mitotane therapy increased over the 20-year time period, this improves recurrence-free and overall survival.