Endocrine Abstracts

Introduction

Adrenocortical carcinoma is a rare neoplasm with local development, rarely metastatic in the spine. We report a case of metastatic dorsal spinal cord compression due to adrenocortical carcinoma.

Observation

A 38-year-old lady with no notable medical history, complained of generalised weakness, severe abdominal pain and spasms. Abdominal computed tomography showed a large right adrenal renal mass measuring 127 * 118 mm infiltrating the tendon center of the diaphragmatic pillar pushing back up the liver and down the kidney with loss of the fatty border. She did not have any signs of hypercortisolism or virilisation. Serum potassium level, oestradiol, testosterone, serum cortisol and 24 h urinary metanephrine were within normal limits. Per operatively, the tumour was free from the kidney and entire adrenal mass was removed with adequate resection margin. Histological examination made the diagnosis of malignant adrenocortical carcinoma. Three days after surgery, she complained of rapidly progressive and continuous back pain, and a sudden heaviness in both limbs. Physical examination revealed proximal paraplegia of the two lower limbs, pyramidal syndrome and hypoaesthesia with a T3 sensory level. A spinal magnetic resonance imaging was performed in emergency visualizing a progressive spinal cord compression secondary to the epidural component of the T3-T4 mass. Decompressive laminectomy and resection of endoluminal tumor material were performed urgently. Histological examination was in favor of spinal metastasis from adrenocortical carcinoma.

Conclusion

Spinal metastasis of adrenocortical carcinoma is exceedingly rare with only few cases having been reported previously. This case highlights the rapid and agressive nature of non-secreting adrenocortical carcinoma causing metastatic dorsal spinal cord compression.