Journal of Yeungnam Medical Science

Case reports

Endocrinology, Diabetes, and Metabolism
Ruptured triple hormone-secreting adrenal cortical carcinoma with hyperaldosteronism, hypercortisolism, and elevated normetanephrine: a case report: Sin Yung Woo, Seongji Park, Kun Young Kwon, Dong-Mee Lim, Keun-Young Park, Jong-Dai Kim; J Yeungnam Med Sci. 2024;41(4):306-311. Published online September 6, 2024; DOI: https://doi.org/10.12701/jyms.2024.00626

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Abstract PDF: We report a case of a ruptured triple hormone-secreting adrenal mass with hyperaldosteronism, hypercortisolism, and elevated normetanephrine levels, diagnosed as adrenal cortical carcinoma (ACC) by histology. A 53-year-old male patient who initially presented with abdominal pain was referred to our hospital for angiocoagulation of an adrenal mass rupture. Abdominal computed tomography revealed a heterogeneous 19×11×15 cm right adrenal mass with invasion into the right lobe of the liver, inferior vena cava, retrocaval lymph nodes, and aortocaval lymph nodes. Angiocoagulation was performed. Laboratory evaluation revealed excess cortisol via a positive 1-mg overnight dexamethasone suppression test, primary hyperaldosteronism via a positive saline infusion test, and plasma normetanephrine levels three times higher than normal. An adrenal mass biopsy was performed for pathological confirmation to commence palliative chemotherapy because surgical management was not deemed appropriate considering the extent of the tumor. Pathological examination revealed stage T4N1M1 ACC. The patient started the first cycle of adjuvant mitotane therapy along with adjuvant treatment with doxorubicin, cisplatin, and etoposide, and was discharged. Clinical cases of dual cortisol- and aldosterone-secreting ACCs or ACCs presenting as pheochromocytomas have occasionally been reported; however, both are rare. Moreover, to the best of our knowledge, a triple hormone-secreting ACC has not yet been reported. Here, we report a rare case and its management. This case report underscores the necessity of performing comprehensive clinical and biochemical hormone evaluations in patients with adrenal masses because ACC can present with multiple hormone elevations.

Hematology
Estrogen-secreting adrenocortical carcinoma: You Jeong, Sung Chul Cho, Hee Joon Cho, Ji Soo Song, Joon Seog Kong, Jong Wook Park, Yun Hyi Ku; Yeungnam Univ J Med. 2019;36(1):54-58. Published online December 20, 2018; DOI: https://doi.org/10.12701/yujm.2019.00017

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Adrenocortical carcinoma is a rare type of endocrine malignancy with an annual incidence of approximately 1–2 cases per million. The majority of these tumors secrete cortisol, and a few secrete aldosterone or androgen. Estrogen-secreting adrenocortical carcinomas are extremely rare, irrespective of the secretion status of other adrenocortical hormones. Here, we report the case of a 53-year-old man with a cortisol and estrogen-secreting adrenocortical carcinoma. The patient presented with gynecomastia and abdominal discomfort. Radiological assessment revealed a tumor measuring 21×15.3×12 cm localized to the retroperitoneum. A hormonal evaluation revealed increased levels of estradiol, dehydroepiandrosterone sulfate, and cortisol. The patient underwent a right adrenalectomy, and the pathological examination revealed an adrenocortical carcinoma with a Weiss’ score of 6. After surgery, he was treated with adjuvant radiotherapy. Twenty-one months after treatment, the patient remains alive with no evidence of recurrence.

Citations

Citations to this article as recorded by

Gynecomastia in a Man With Adrenal Mass
Jasmine Saini, Patrick Navin, Michael Rivera, Irina Bancos
JCEM Case Reports.2023;[Epub] CrossRef
Adrenocortical Carcinoma: Updates of Clinical and Pathological Features after Renewed World Health Organisation Classification and Pathology Staging
Alfred King-yin Lam
Biomedicines.2021; 9(2): 175. CrossRef

Case Report

Endocrinology, Diabetes, and Metabolism
A Case of Adrenocortical Carcinoma Secreting Cortisol and Aldosterone.: Jiyoon Ha, Min Kyung Kim, Yoon Jin Cha, Seung Kyu Kim, Gi Young Yun, Kwangwon Rhee, Joon Seong Park, Eun Suk Cho, Chul Woo Ahn, Jong Suk Park; Yeungnam Univ J Med. 2012;29(2):132-135. Published online December 31, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.2.132

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Abstract PDF: Adrenocortical carcinomas are rare and frequently aggressive tumors that may be functional (hormone-secreting) and may cause Cushing's syndrome or virilization, or non-functional and manifest as an abdominal mass. This paper reports the case of a 77-year-old woman with cortisol- and aldosterone-secreting adrenal carcinoma. The patient complained of general weakness, a moon face, and weight gain. She also had hypokalemia and hypertension. Her endocrinological data showed excessive aldosterone production and non-suppressible cortisol production in a low-dose dexamethasone suppresion test. Her abdominal CT showed a right adrenal mass. She underwent right adrenalectomy, and her histology revealed the presence of adrenocortical carcinoma. After adrenalectomy, her hypokalemia returned to normal and she is being treated with hydrocortisone.

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