Endocrine Abstracts

Introduction: Adrenal cortical carcinoma (ACC) is a rare and aggressive malignancy. Most patients (80%) are asymptomatic at the time of diagnosis. ACC generally has a poor prognosis with a 5-year survival rate of 20–25%.

Case: A 37-year-old man came to the Hospital of Lithuanian University of Health Sciences Kaunas Clinics for general weakness, fatigue, intermittent abdominal pain, and weight loss (~ 10 kg in 9 months). During the abdominal US, the mass in the right adrenal gland was found. Physical examination: no clinical signs of hypercortisolemia and no changes in other endocrine systems were observed.

Laboratory tests: Diagnosis of pheochromocytoma and primary hyperaldosteronism excluded. 26.10.20 – 1 mg of Dexamethasone test – no suppression of cortisol was detected, low-dose and high dose Dexamethasone suppression tests – pathologic (Table 1).

Abdominal CT: In the right adrenal gland – ~ 4.6×4.1 cm mass, non-homogeneous with microcalcifications, unevenly accumulates contrast. Laparoscopic right adrenalectomy was performed.

Macroscopic examination: Right adrenal gland 7.5×5×4 cm, in incisions yellowish 5×4.5×3.1 cm mass.

Microscopic examination: About 50% of the tumor consists of cells, which layout in lobular and alveolar structures. Cells are medium-sized with round, chromatic nuclei and a moderately abundant, mildly eosinophilic cytoplasm. Another component of the tumor takes up to 3.0 cm of the tumor itself and is formed by polymorphic medium-sized and large atypical cells with highly accentuated, polymorphic, and chromatic nuclei. The cells have mildly eosinophilic cytoplasm of varying abundance. Part of the tumor cells is monstrous. Narrow areas of tumor necrosis and wide inclusions of fibrous tissue were found. No overgrowth of the fibrous adrenal capsule was found.

Conclusion: adrenal cortical carcinoma against the background of cortical adenoma pT1 Nx Mx LVI R0.

Chest and abdominal CT: Right adrenal gland is removed, no signs of metastases were observed, left-without changes.

DXA: Osteopenia. MEN1, Beckwith-Wiedemann, and Lynch syndromes were ruled out by genetic tests. Post-operative treatment included Hydrocortisone 20–30 mg/d replacement therapy. Renin, aldosterone, cortisol (in the background of Hydrocortisone use), ACTH, electrolytes – all in the normal range (Table 1).

Conclusion: Non-functioning adrenal carcinoma and its nonspecific clinic may be a challenge in the diagnosis of the disease and require careful clinical examination. Nonspecific clinics of adrenal cortical carcinoma can often lead to a late diagnosis, leading to local and systemic progression of the disease.