Aliño Meghan Marie, Tam-Go Lyzanne Maryl
Department of Internal Medicine, Chong Hua Hospital, Cebu City, Philippines.
J ASEAN Fed Endocr Soc. 2024;39(2):103-107. doi: 10.15605/jafes.039.02.13. Epub 2024 Aug 27.
Adrenocortical carcinoma (ACC) accounts for 0.05-2% of all malignant tumors. Forty-five percent of ACCs with secretory function have excess glucocorticoids alone and only less than 1% secrete aldosterone. This is a case of a 44-year-old Filipino female with hypertension and a 12-year-history of an incidentaloma of the left adrenal gland, with recent-onset complaints of increasing abdominal girth, purple striae, amenorrhea, moon facies and a dorsocervical fat pad. Laboratory findings revealed low potassium levels, non-suppressed cortisol on dexamethasone test suggesting Cushing's syndrome and elevated aldosterone-renin ratio and plasma aldosterone concentration pointing to primary hyperaldosteronism. A computed tomography scan revealed a left-sided adrenal mass measuring approximately 23 cm in largest diameter suggestive of carcinoma without metastasis or lymph node involvement. Complete resection via open adrenalectomy was performed and histopathologic assessment revealed Adrenocortical Carcinoma with Weiss score of 4. The Ki-67 proliferative index was found to be >20%. Radiotherapy was done as an adjuvant treatment. Although rare, co-secretion of cortisol and aldosterone can occur in functional tumors of adrenocortical carcinoma. Malignancy should always be considered in patients who present with a history of a unilateral adrenal mass and/ or in those with signs and symptoms of adrenal hormone excess. Thus, a proper assessment derived from a thorough medical history, physical examination and laboratory work-up is warranted in patients with an adrenal mass to ascertain the diagnosis and provide adequate management.
肾上腺皮质癌（ACC）占所有恶性肿瘤的0.05%-2%。45%具有分泌功能的ACC仅存在糖皮质激素过多，而仅不到1%分泌醛固酮。这是一例44岁的菲律宾女性患者，患有高血压，左侧肾上腺意外瘤病史12年，近期出现腹围增大、紫纹、闭经、满月脸和颈背部脂肪垫等症状。实验室检查结果显示低钾血症、地塞米松试验中皮质醇未被抑制提示库欣综合征，醛固酮-肾素比值升高和血浆醛固酮浓度升高提示原发性醛固酮增多症。计算机断层扫描显示左侧肾上腺肿块，最大直径约23 cm，提示为无转移或淋巴结受累的癌。通过开放性肾上腺切除术进行了完整切除，组织病理学评估显示为肾上腺皮质癌，Weiss评分为4分。发现Ki-67增殖指数>20%。作为辅助治疗进行了放疗。虽然罕见，但肾上腺皮质癌的功能性肿瘤可同时分泌皮质醇和醛固酮。对于有单侧肾上腺肿块病史和/或有肾上腺激素过多体征和症状的患者，应始终考虑恶性肿瘤的可能。因此，对于肾上腺肿块患者，有必要通过详细的病史、体格检查和实验室检查进行恰当评估，以明确诊断并提供充分的治疗。
