Marino Michael John, Markley Webster Sara
Department of Graduate Medical Education, Northside Hospital Gwinnett, Lawrenceville, Georgia.
Division of Endocrinology, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia.
AACE Clin Case Rep. 2023 Mar 17;9(3):77-80. doi: 10.1016/j.aace.2023.03.002. eCollection 2023 May-Jun.
BACKGROUND/OBJECTIVE: To describe a case highlighting a rare malignancy that can be camouflaged by the hormonal milieu of pregnancy.
We present the case of a 28-year-old pregnant female who was diagnosed with stage IV metastatic adrenocortical carcinoma at 15-weeks gestation. The patient declined palliative chemotherapy at first with the hope of continuing her pregnancy. She had elevated dehydroepiandrosterone sulfate, testosterone, and cortisol levels consistent with Cushing's syndrome and hyperandrogenism. The patient eventually had a spontaneous abortion and elected to start chemotherapy and mitotane treatment. She passed away 3 months after initial presentation.
Adrenocortical carcinoma is difficult to detect and diagnose in pregnant patients because of the physiologic hormonal changes that take place during gestation. The patient described in this case report is an example of this diagnostic challenge.
Adrenocortical carcinoma is a rare, fatal disease that often presents at an advanced stage with limited treatment options making earlier diagnosis imperative; however, diagnosis and treatment are complicated by pregnancy. More data is necessary to determine how best to approach these challenges in future patients.
背景/目的：描述一例凸显可被孕期激素环境掩盖的罕见恶性肿瘤的病例。
我们报告一例28岁的妊娠女性病例，该患者在妊娠15周时被诊断为IV期转移性肾上腺皮质癌。患者起初拒绝姑息化疗，希望继续妊娠。她的硫酸脱氢表雄酮、睾酮和皮质醇水平升高，符合库欣综合征和高雄激素血症。患者最终自然流产，并选择开始化疗和米托坦治疗。她在初次就诊3个月后去世。
由于孕期发生的生理性激素变化，肾上腺皮质癌在妊娠患者中难以检测和诊断。本病例报告中描述的患者就是这一诊断挑战的一个例子。
肾上腺皮质癌是一种罕见的致命疾病，通常在晚期出现，治疗选择有限，因此早期诊断至关重要；然而，妊娠会使诊断和治疗变得复杂。需要更多数据来确定未来如何最好地应对这些挑战。
