Endocrine Abstracts

Background: Adrenocortical carcinomas (ACC) are rare malignancy with an incidence of 0.7-2 per million population per year. While ~60% of ACC are functional, clinical manifestations of hyper-secretion are seen in only ~40% of the cases. Here, we report a case of ACC with initial presentations of hypokalemia and hypertension mimicking hyperaldosteronism

Case report: A 37 year old male complaining of generalized weakness of 2 years duration and fatigue with limitation of daily physical activities, the condition wasn’t not associated trauma, convulsions, fever or disturbed consciousness level 8 months ago the patient developed another attack of severe weakness and fatigue, he sought medical advice, investigations were done and showed severe hypokalemia for which he was admitted to ICU and was discovered to be hypertensive. His blood pressure was 180/100 mmHg, pulse:100 / minute regular, respiratory rate:18/min, oxygen saturation: 96%. Examinations were unremarkable. Hematological, renal, liver function&thyroid function test were in the normal range serum sodium was 146 mmol/l (N:136-145) mmol/l potassium (1.5 mmol), His antihypertensive medications were optimized and started on Losartan, amlodipine, Beta-blocker, alpha-blocker, and diuretics (spironolactone). An extensive evaluation was done to find the cause of hypokalemia. Serum Cortisol AM 4.6 (6.2 – 19.4 mg/dl) ACTH AM 10 (7.2 – 63.3 pg/ml) Plasma renin activity 14.81 (3–33 pg/ml) Plasma aldosterone 270 (10–310 pg/ml) Urinary VMA 3.9 (1.0–7.0 mg/day) The contrast-enhanced CT abdomen showed well defined, smooth, heterogeneously enhancing mass lesion in the left adrenal gland measuring 11.4 cm × 10.3 cm × 11 cm with central necrosis. Color Doppler of bilateral renal arteries showed normal flow. ABG showed metabolic alkalosis. Potassium was supplemented from the IV route as well as the oral route After confirming our diagnosis, He underwent laparoscopic unilateral adrenalectomy (left) and intraoperative and postoperative periods were uneventful. The Operated left adrenal mass. Histopathological examination showed atypical cells showing marked pleomorphic exhibiting small cells to giant bizarre-shaped cells indicating adrenocortical carcinoma. The capsular invasion was seen (Weiss score 8) He was discharged with antihypertensive medications (calcium channel blocker and alpha-blocker), planned to taper off, Blood Pressure and potassium reached normal range after 3 month

Conclusion: Management for ACC requires a multidisciplinary approach. The principal considerations are surgical, which is the only curative option for ACC Secondary hypertension from aldosterone secreting ACC is not only uncommon but may also be unfamiliar to the practicing clinicians