Introduction: Adrenocortical carcinoma is a rare tumor with an incidence of 1 per million per year. It occurs in two age groups: in children under 5 years old and in adults from 4th to 6th decade of life. It is potentially curable at an early stage, unfortunatelly, about 70% of these tumors are detected late. Functional carcinomas are present with about 60% with endocrine syndrom: Cushing syndrome (30%); Virilization and premature puberty (22%); Feminization (10%); Primary hyperaldosteronism (2.5%); Combined hormonal excess (35%).
Case report: Postmenopausal, 60 years old woman reported uterine bleeding to a gynaecologist in November 2011. Clinical examination, ECHO and PAPA were non-specific. PH finding after fractionated curettage: Hyperplasia endometrii simplex. Bleeding continued persistently and she was radically gynecologically operated in July 2012. PH finding: Adenomyosis uteri. After surgery: hyperglycaemia, swelling of the legs, gaining in the body weight, redness of the face, hirsutism and non controlled blood pressure occurred. Diagnosed diabetes, highly elevated, non suppressed cortisol in overnight DEX test 1500 nmol/l, LDDST cortisol 1656.0 nmol/l, testosterone 19.2 nmol/l, DHEAS 9.3 mcmol/l, A-dion 18.1 nmol/l, estradiol 2417 pmol/l and Ca19-9 212.3. Gonadotropins and ACTH were suppressed. Aldosteron/ renin and cateholamins were normal. CT scan presented a large, inhomogeneous, low fat content tumor of the left adrenal gland 150×74 mm, which suppressed the left kidney caudally, enlarged retroperitoneal and periaortal lymph nodes up to 24 mm in diameter and secondary deposits in the lungs. She was operated on May 2013, left adrenalectomy, left nephrectomy and splenectomy were done. PH finding: Carcinoma glandulae suprarenalis Weiss scor 6. Early post-operative course was accompanied by numerous severe complications: intra-abdominal bleeding, pulmonary thromboembolism, thrombosis and tumor infiltration of the inferior cava vein and sepsis (Klebsiella). Treatment of complications lasted for 6 months. Patient survived complications. Due to her poor general condition, the Neuroendocrine Tumor Consilium has decided to continue treatment with mitotane at the maximum tolerable dose. In the further course of the disease she was taking mitotan discontinuously, in a reduced dose due to intolerance. She died in July 2017.
Conclusions: i) It is necessary to check the level of estrogen, androgens and gonadotropins in the evaluation of inexplainable vaginal bleeding in postmenopausal age as well as generative age. ii) If hormonal testing was done, our patient would avoid unnecessary gynecological surgery, and the underlying disease wouldve been diagnosed earlier, when it was potentially curable.
18 May 2019 - 21 May 2019