Benign adrenal adenoma transforming to adrenocortical carcinoma - the challenge in consultation with patient and family in this rare occurrence

Adrian James; Sarishka Singh; Asher Alam; Mehdi Raza; Oran Roche; Somsundaram Ramkumar; Nicole Bottoms; Lisa Ward; Shiji Payyappilly; Ritwik Banerjee; Lim Chung Thong

doi:10.1530/endoabs.109.P302

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Endocrine Abstracts (2025) 109 P302 | DOI: 10.1530/endoabs.109.P302

SFEBES2025 Poster Presentations Late Breaking (68 abstracts)

Benign adrenal adenoma transforming to adrenocortical carcinoma – the challenge in consultation with patient and family in this rare occurrence

Adrian James , Sarishka Singh , Asher Alam , Mehdi Raza , Oran Roche , Somsundaram Ramkumar , Nicole Bottoms , Lisa Ward , Shiji Payyappilly , Ritwik Banerjee & Chung Thong Lim

Author affiliations

Luton and Dunstable University Hospital, Luton, United Kingdom

Introduction: The transformation of benign adrenocortical adenoma (ACA) to adrenocortical carcinomas (ACC) are extremely rare (<1%). In this situation, it is often very challenging in breaking the bad news to patients and families. We present a case of 69-year old female investigated for an incidental ACA with stable radiological appearance over 3 years but unfortunately transformed into ACC in just over 12 months.

Case Presentation: A 69-year old non-smoker lady with background of bronchiectasis, single agent- and well-controlled type 2 diabetes and hypertension, was found to have an incidental well-defined right sided adrenal nodule (26x17x36mm) on CT chest for bronchiectasis investigation. The lesion did not meet the signal dropout criteria for a benign lesion, but over 3 years of follow up, the radiological appearance remained stable. Clinically, she did not exhibit features suggestive of hormonal hypersecretion. Her biochemistry suggested possible mild autonomous cortisol secretion (MACS) but otherwise unremarkable renin, aldosterone, 24-hour urinary catecholamines, DHEAS, testosterone, and 24-hour urinary steroid profile (USP). After adrenal MDT discussion and with patient, we agreed to discharge her with community monitoring of metabolic markers in view of MACS. Unfortunately, she represented with severe hyperglycaemia in a years’ time. Her CT imaging showed significant increase in size of the previous ACA (100x45x60mm). Repeat adrenal biochemistry showed clear-cut hypercortisolism and significant difference in the 24-hour USP, suggesting steroid excess and possible ACC. Full radiological screening including PET-CT confirmed a solitary adrenal mass. Breaking the bad news to an understandably upset patient and family was extremely challenging in view of the rare occurrence and previous reassurance of the benignity. She underwent a right adrenalectomy when stable.

Learning Point: Although rare, it’s crucial to highlight the small risk of ACA transforming to ACC. However, the balance of doing this with risk of ‘over-worrying’ the patient needs to be achieved.