Aldosterone-secreting adrenocortical carcinoma (ACC) is rare neoplasm, which detected in 2.5% of active ACCs.
Clinical case: A 58 years old female, was admitted to our clinic with complaints of high blood pressure, back pain, weakness, convulsions. Biochemical evaluation confirmed primary hyperaldosteronism (serum aldosterone 1012 pg\ml, serum renin concentration 0.5 mkME\ml, aldosterone-renin ratio 202.4, hypokalemia 1.2 mmol\l). There was no evidence of cortisol co-secretion on standart low-dose dexamethasone test. The level of metanephrine and normetanephrine in urine were in normal range. A CT scan with contrast-enhanced identified right adrenal tumor 8*6*9 cm with heterogeneous structure. Native density of tumor was 38 Hounsfield units (HU). In arterial and venous phase tumor density was 70 HU, delayed - 55 HU. Dynamics of growth was +5 cm in 6 months. Surgical treatment was performed: in the right retroperitoneal there was tumor about 15 cm in diameter, comressed the inferior vena cava, right renal artery, and renal veins. Adrenalectomy with a tumor and lymph node dissection was performed. Histological examination revealed adrenocortical cancer. Ki-67 expression was up to 75% in hot spots. Number of Weiss score - 6. A 1.5 month follow-up CTscan was no evidence of local reccurence. Serum aldosterone level was in normal range.
Although rare, this case demonstrates the ability of this pathology, and therefore requires caution against the ACC at the small size of the tumor. As a method of follow-up screening can be a controlling level of aldosterone and potassium in the blood and monitoring blood pressure. To improve the results of treatment these patients it is necessary to conduct studies with larger numbers of patients, as well as development of new diagnostic and prognostic criteria allowing to improving diagnosis ACC before and after surgery.
20 May 2017 - 23 May 2017