Endocrine Abstracts

Introduction: Adrenocortical carcinoma (ACC) is a rare malignancy with estimated annual incidence of 0,7 to 2 cases per milion, and it is more commonly diagnosed in women. Being extremely agressive entity, survival median of four years is not suprising. Hormone secreting ACC is found in 60% of patients diagnosed with disease, whereas isolated hyperandrogenism is found in 3-5% cases of adult patients.

Case presentation: We present the case of 63-year-old patient who was hospitalized in endocrinology department for functional testing of adrenal incidentaloma. She presented with abdominal pain and fatigue and malaise, clinically she was obese with signs of hyperandrogenemia i.e. marked hirsutism. In laboratory results we found increased values of DHEAS of 1073\.1326,2 mg/dl and testosteron: 2,09 ng/ml, while ACTH, daily cortisol, renin, aldosteron and 24h urinary catecholamine values were in refferent range. The Chest CT revealed no abnormalities, while abdominal NMR detected expansive heterogeneous mass with smaller zones of necrosis sized 11 × 9.4 × 11.5 cm with suppression of the pancreas but without signs of infiltration of surrounding structures. Abdominal surgeon was consulted, patient was operated on and pathohistology finding showed adrenal cortical carcinoma Fuhrman grade III, pT2, Ki67 <5%, ENSAT stage 2. Patient was reffered to higher instance for the decision of whether to introduce adjuvant therapy, which was not instituted at the time. In the further course of treatment, disease recurrence was verified, she was reoperated on and adjuvant mitotane was introduced. Patient died 12 months upon diagnosis.

Conclusion: As already stated, ACC is highly invasive malignancy with poor treatment outcome regardless of therapeutic measures. Further research is needed to assess the best therapeutic modality in recurrent disease.