An Unusual Case of Adrenocortical Carcinoma with Multiple Facets
A Case Report
DOI:
https://doi.org/10.15605/jafes.039.02.16Keywords:
adrenocortical carcinoma, pheochromocytoma, urine fractionated metanephrinesAbstract
Adrenocortical carcinoma (ACC) is a rare malignant tumour originating from the adrenal cortex. Half of the cases are functional, with ACTH independent autonomous cortisol production being the most common. It is rare for ACC to present with markedly elevated metanephrine levels which is a typical characteristic of pheochromocytoma. We report a case of a large functioning adrenal tumour with overlapping biochemistry features of ACC and pheochromocytoma. Biopsy confirmed the histopathological diagnosis of metastatic ACC.
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Fassnacht M, Dekkers OM, Else T, et al. European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2018;179(4):G1-46. https://pubmed.ncbi.nlm.nih.gov/30299884 https://doi.org/10.1530/EJE-18-0608
Fassnacht M, Assie G, Baudin E, et al. ESMO Guidelines Committee. Adrenocortical carcinomas and malignant phaeochromocytomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020;31(11):1476-90. https://pubmed.ncbi.nlm.nih.gov/32861807 https://doi.org/10.1016/j.annonc.2020.08.2099. Erratum in: Ann Oncol. 2023;34(7):631. https://pubmed.ncbi.nlm.nih.gov/32861807 https://doi.org/10.1016/j.annonc.2022.12.006
Lenders JW, Duh QY, Eisenhofer G, et al; Endocrine Society. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(6):1915-42. https://pubmed.ncbi.nlm.nih.gov/24893135 https://doi.org/10.1210/jc.2014-1498. Erratum in: J Clin Endocrinol Metab. 2023;108(5):e200. https://doi.org/10.1210/clinem/dgad064
Harding JL, Yeh MW, Robinson BG, Delbridge LW, Sidhu SB. Potential pitfalls in the diagnosis of phaeochromocytoma. Med J Aust. 2005;182(12):637-40. https://pubmed.ncbi.nlm.nih.gov/15963022
Young WF Jr. Clinical presentation and diagnosis of pheochromocytoma. Katya Rubinow (ed). UpToDate. 2024. https://medilib.ir/uptodate/show/130
Yu R, Nissen NN, Chopra P, Dhali D, Phillips E, Wei M. Diagnosis and treatment of pheochromocytoma in an academic hospital from 1997 to 2007. Am J Med. 2009;122(1):85-95. https://pubmed.ncbi.nlm.nih.gov/19114176. https://doi.org/10.1016/j.amjmed.2008.08.021.
González-Fernández L, Añez-Ramos RJ, Rivas-Montenegro AM, Moreno DM, Percovich-Hualpa CJ. Metanephrin-producing adrenocortical carcinoma: a case report. Revista Latinoamericana de Hipertensión. 2021;16(2):173-7.
https://doi.org/10.5281/zenodo.5514202.
Alsabeh R, Mazoujian G, Goates J, Medeiros LJ, Weiss LM. Adrenal cortical tumors clinically mimicking pheochromocytoma. Am J Clin Pathol. 1995;104(4):382-90. https://pubmed.ncbi.nlm.nih.gov/7572786. https://doi.org/10.1093/ajcp/104.4.382.
Nieman LK. Establishing the cause of Cushing syndrome. Katya Rubinow (ed). UpToDate. 2024. https://medilib.ir/uptodate/show/125
Pecori Giraldi F, Saccani A, Cavagnini F; Study Group on the Hypothalamo-Pituitary-Adrenal Axis of the Italian Society of Endocrinology. Assessment of ACTH assay variability: a multicenter study. Eur J Endocrinol. 2011;164(4):505-12. https://pubmed.ncbi.nlm.nih.gov/21252174 https://doi.org/10.1530/EJE-10-0962
Invitti C, Pecori Giraldi F, de Martin M, Cavagnini F. Diagnosis and management of Cushing's syndrome: results of an Italian multicentre study. Study Group of the Italian Society of Endocrinology on the pathophysiology of the hypothalamic-pituitary-adrenal axis. J Clin Endocrinol Metab. 1999;84(2):440-8. https://pubmed.ncbi.nlm.nih.gov/10022398 https://doi.org/10.1210/jcem.84.2.5465
Dilrukshi MDSA, Wickramarachchi AW, Abeyaratne DDK, Shine B, Jafar-Mohammadi B, Somasundaram NP. An adrenocortical carcinoma associated with non-islet cell tumor hypoglycemia and aberrant ACTH production. Case Rep Endocrinol. 2020;2020:2025631. https://pubmed.ncbi.nlm.nih.gov/32231811 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085350 https://doi.org/10.1155/2020/2025631
Law A, Hague WM, Daly JG, et al. Inappropriate ACTH concentrations in two patients with functioning adrenocortical carcinoma. Clin Endocrinol (Oxf). 1988;29(1):53-62. https://pubmed.ncbi.nlm.nih.gov/2854760 https://doi.org/10.1111/j.1365-2265.1988.tb00249.x
Simonds WF. Expressions of Cushing's syndrome in multiple endocrine neoplasia type 1. Front Endocrinol (Lausanne). 2023;14:1183297. https://pubmed.ncbi.nlm.nih.gov/37409236 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10319112 https://doi.org/10.3389/fendo.2023.1183297
Thakker RV, Newey PJ, Walls GV, et al; Endocrine Society. Clinical practice guidelines for multiple endocrine neoplasia type 1 (MEN1). J Clin Endocrinol Metab. 2012;97(9):2990-3011. https://pubmed.ncbi.nlm.nih.gov/22723327 https://doi.org/10.1210/jc.2012-1230
Kimura N, Motoyama T, Saito J, Nishikawa T. Mixed corticomedullary tumor of the adrenal gland. Front Endocrinol (Lausanne). 2022;13:1026918. https://pubmed.ncbi.nlm.nih.gov/36187098 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524188 https://doi.org/10.3389/fendo.2022.1026918
Fassnacht M, Tsagarakis S, Terzolo M, et al. European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2023;189(1):G1-42. https://pubmed.ncbi.nlm.nih.gov/37318239 https://doi.org/10.1093/ejendo/lvad066
Kubo H, Tsurutani Y, Sunouchi T, et al. A case of 123I-metaiodobenzylguanidine scintigraphy-negative pheochromocytoma with a tumor-developing mutation in the RET Gene. J Clin Med. 2022;11(15):4624. https://pubmed.ncbi.nlm.nih.gov/35956242 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9369916 https://doi.org/10.3390/jcm11154624
Williams AR, Hammer GD, Else T. Transcutaneous biopsy of adrenocortical carcinoma is rarely helpful in diagnosis, potentially harmful, but does not affect patient outcome. Eur J Endocrinol. 2014;170(6):829-35. Phttps://pubmed.ncbi.nlm.nih.gov/24836548 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4096775 https://doi.org/10.1530/EJE-13-1033
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