Endocrine Abstracts

Background: Adrenocortical carcinoma is a rare malignancy with a poor prognosis. Local recurrence is affected by the pathologic features (tumor staging and mitotic index) and the complete surgical resection. Treatment of a recurrent adrenocortical carcinoma can be a real challenge.

Case description: We report a case of 47-year-old man who was operated for an adrenal tumor with bone metastases. Left adrenalectomy and splenectomy were performed and histology confirmed the diagnosis of adrenocortical carcinoma. Five cycles of chemotherapy (Cisplatin and bisphophonate) were given. The patient presented an adrenal deficiency and a 10 mg glucocorticoid replacement therapy was prescribed. Seven years later, he presented dyspnea and fatigue with no other clinical or biological abnormalities. CT scan showed a left adrenal tumor of 40×30 mm and a suspected voluminous lymph node of a 90×63 mm with invasion of the left pulmonary artery and multiple suspected pulmonary lesions. Cortisol failed to suppress after low dose and high dose on Dexamethasone suppression test. Surgery was not possible and the patient continued to deteriorate despite chemotherapy and was subsequently referred to palliative care.

Discussion: Due to the rarity of the adrenocortical carcinoma, the understanding and experience of management modalities is limited. New treatment options may be available in the coming years to improve outcome. Early identification of tumor is the key to improve the prognosis of the disease.