Endocrine Abstracts

Introduction: Adrenocortical carcinomas (ACC) are rare and aggressive, with a mean five-year survival rate ranging between 20% and 50%. These tumours often lead to excessive hormone production further complicating management. We report a patient with abdominal pain who was eventually diagnosed with adrenocortical carcinoma.

Case report: A 53 year old man presented to primary care with 1 month history of abdominal pain. A community ultrasound revealed adverse findings, which prompted admission to our tertiary hospital. Computed tomography of abdomen in hospital showed large right sided mass (21 cm maximum diameter) reported as probable adrenocortical carcinoma with hepatic and pulmonary metastases, and thrombus in IVC. There was biochemical evidence of cortisol and androgen hypersecretion, although patient was not overtly Cushingoid. Biopsy was performed, patient was started on metyrapone and referred to the local adrenal MDT, then discharged 12 days after admission. Local MDT deemed patient inoperable and he was referred to the regional neuroendocrine MDT, subsequent plan was to schedule an FDG PET-CT scan, this showed metastatic right adrenal malignancy. Histology and immunohistochemistry confirmed adrenocortical carcinoma. On the next MDT, patient was re-admitted to our centre with new respiratory compromise and malignant hypercalcaemia (unusual in ACC). The MDT decision was for mitotane therapy, however patient was no longer fit for transfer to the quaternary centre. Local oncology teams reviewed but felt as performance status had declined from 1 to 3, he was not fit for any other chemotherapy either. He was subsequently placed on palliative care 6 weeks after first hospital admission and died a few days later.

Learning points: 1. ACC is often diagnosed late and requires prompt treatment due to its aggressive nature. 2. Increasing the availability of chemotherapy outside quaternary centres may allow for treatment to be initiated in the narrow time window that patients with ACC have.