Endocrine Abstracts

Background: Adrenal cortical carcinoma (ACC) is a rare and aggressive neoplasm that frequently presents with nonspecific symptoms, complicating diagnosis. This case reports a 41-year-old female with a history of left adrenalectomy for oncocytic ACC, who subsequently developed a right adrenal lesion.

Case Presentation: The patient initially underwent left adrenalectomy after imaging revealed a large left adrenal mass measuring 3.1 x 2.8 cm with a precontrast Hounsfield unit of 24. A PET scan indicated a mass size of 2.5 cm with a standardized uptake value of 15.2. Postoperative pathology confirmed the diagnosis of oncocytic adrenocortical carcinoma. Functional studies for adrenal hormones and genetic screenings for tumor syndromes unremarkable. The patient received adjuvant radiotherapy to the left adrenal bed for local control. Eight years post-surgery, a follow-up CT scan showed no signs of recurrence, although an unchanged right adrenal adenoma was noted. However, subsequent MRI revealed a right adrenal lesion measuring 1.7 cm, characterized by T2 hyperintensity and heterogeneous enhancement. The accompanying PET scan demonstrated a non-FDG avid 2.5 x 1.7 cm right adrenal nodule. Laboratory evaluations, including urinary dopamine, metanephrines, DHEAS, dexamethasone suppression test remained within normal limits. Adrenal biopsy showed adrenal cortical proliferation, leading to a right adrenalectomy, which yielded post-surgical pathology favoring carcinoma (Ki 67 index 18%). The patient was then initiated on hydrocortisone and fludrocortisone.

Discussion/Conclusion: ACC is associated with a high recurrence rate and poor prognosis, necessitating careful monitoring following surgery. Imaging modalities such as MRI and PET scans are essential for evaluating adrenal masses, although non-FDG avid lesions can complicate diagnosis. The evolving role of genetic screening, particularly for syndromes like Li-Fraumeni and Lynch syndrome, is significant. This case highlights the complexities of managing ACC and underscores the importance of diligent monitoring, comprehensive clinical evaluation, and effective endocrinological management post-surgery.