A 51‐year‐old white man with a medical history of acid reflux and Bell's palsy presented to the clinic with several months’ history of nausea, abdominal fullness, bloating, and left upper quadrant pain with radiation to the left flank. Physical examination revealed tenderness to palpation in the left upper quadrant and left flank. Family history was unremarkable for any cancer or endocrine disease. Social history was negative for alcohol and tobacco use. The patient was evaluated with abdominal ultrasound, which revealed a large, 10‐cm mass in the upper portion of the left kidney. A follow‐up CT scan of the abdomen and pelvis demonstrated a 15 × 11 × 10.5 cm mass of the left adrenal gland, accompanied by multiple bibasilar pulmonary nodules and 2 hypodense lesions in the liver. Given the suspicion of metastatic disease to the liver, the patient was worked up for colon cancer. Colono‐scopy revealed mild sigmoid diverticulosis and esophago‐gastroduodenoscopy revealed changes consistent with reflux esophagitis and mild gastritis. A laboratory panel was performed in order to determine the functionality of the adrenal mass, which revealed ACTH 16.2 (7.2–63.3), serum cortisol 15.57 (4.30–22.40), DHEA 709 (31–701), normetanephrine 54 (0–145), and metanephrine 13 (0– 62). Surgical biopsy of the left adrenal mass and the right lung nodule revealed cells resembling adrenal cortical parenchyma. Neoplastic cells were found to be strongly positive for the immunohistochemical stains chromogranin and synaptophysin. CD10 showed focal positivity among the neoplastic cells. These findings were most consistent with the diagnosis of stage IV primary adrenal cortical carcinoma. The patient was subsequently started on palliative mitotane chemotherapy.
Primary adrenocortical carcinomas (ACC) have a reported incidence of approximately 2 per million per year, accounting for 0.2% of cancer‐related deaths. The prognosis is poor, with a median survival time of only 6 months if left untreated. Patients who present without any sign of endocrine activity often report symptoms of fever, weight loss, abdominal discomfort, abdominal mass, hematu‐ria, and hypertension. As demonstrated by this case, recognition of these common symptoms are essential in making a diagnosis of ACC and initiating therapy. Primary treatment of ACC consists of surgery followed by administration of the adrenocorticolytic antineoplastic agent mitotane.
Adrenocortical carcinomas are a rare type of neoplasm that may arise from any layer of the adrenal cortex. Despite being a rare tumor, it should be considered in patients complaining of flank pain, weight loss, and abdominal discomfort with or without hormone production by the tumor.
V. Faridani ‐ none; K. Khosa ‐ none; A. Aktha ‐ none; N. Roldan ‐ none; N. Chaada ‐ none; A. Shwaiki ‐ none
To cite this abstract:Faridani V, Aktha A, Khosa K, Roldan N, Chadha N, Shwaiki A. Primary Adrenocortical Carcinoma: A Rare Diagnosis with Common Symptoms. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 274. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/primary-adrenocortical-carcinoma-a-rare-diagnosis-with-common-symptoms/. Accessed April 8, 2020.