We describe case of 29-year woman with no concomitant illneses in her history and with negative family history in sense of adrenal or cancer disease.
She came first in February 2012 for secondary hypomenorrhea lasting for 3 months, hirsutism and worsening of acne. Laboratory examination reveals markedly elevated free testosterone (9.6 nmol/l) and slightly elevated morning cortisol (687.4 nmol/l) with almost no suppresion in low dose dexamethasone suppresion test (1 mg) and elevated DHEA-S. On CT scan was diagnosed multinodular adrenal tumor 70×45 mm (60 HU) in right adrenal gland, left adrenal was normal. In lower part of right liver lobe was small hypodense locus 21×15 mm suspected to metastasis. Feochromocytoma was excluded by assessment of plazmatic metanephrines.
In April 2012 surgery was performed wedge-shaped excision of liver tumor and right adrenalectomy, biopsy of liver was benign cavernous haemangioma. Biopsy of adrenal gland was described in first reading as feochromocytoma. After sugery, menstruation cycle, hirsutism, acne, level of plasma cortisol, free testosterone and cortisol after suppresion were normalized. For clinical discrepance I initiated second reading of adrenal biopsy and the conclusion was oncocytic variant of adrenal carcinoma.
In June 2012 PET/CT scan was performed, with negative results. Synacten test after surgery showed sufficient cortisol reserve. Patient is now in our dispensarization, in conclusion with oncologist no adjuvant treatment was recommended.
In comparison with literature, testosterone-secreting oncocytic adrenocortical carcinoma was firstly described in 2010 in New Zealand and our case is probably the third case of this extremely unique malignancy in the world.
27 Apr - 01 May 2013
European Society of Endocrinology