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Hussain ZS, Rao SS, Hussain WZ, Puzhakkal S. Potassium losing, aldosterone producing adrenocortical carcinoma: a rare presentation. BMJ Case Rep 2020; 13:e235317. [PMID: 32912887 PMCID: PMC7482498 DOI: 10.1136/bcr-2020-235317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 11/04/2022] Open
Abstract
Adrenocortical carcinomas (ACCs) are rare malignancies with an incidence of one to two per million per year. Aldosterone-producing ACCs (APACs) are extremely rare with an incidence less than 1%. We describe a rare case of APAC, presenting with episodic lower-limb weakness and hypertension. Our patient was found to have serum aldosterone levels of 20.8 ng/dL (2.5-15.2) with persistent hypokalaemia and a 9.7×8.3×7.7 cm right adrenal mass, which was suspicious of malignancy on evaluation. He underwent a complete surgical resection which confirmed the diagnosis of ACC and normalised his aldosterone and potassium levels. He was then subjected to postoperative chemotherapy. Postoperative adjuvant chemotherapy with mitotane has a role in preventing recurrence.
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Affiliation(s)
- Zahir S Hussain
- Department of Endocrine and Breast Surgery, Madras Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Smitha S Rao
- Department of Endocrine and Breast Surgery, Madras Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Wajith Z Hussain
- Department of Endocrine and Breast Surgery, Madras Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Shikhil Puzhakkal
- Department of Endocrine and Breast Surgery, Madras Medical College and Research Institute, Chennai, Tamil Nadu, India
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Claimon A, Tantranont N, Claimon T. 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography for preoperative planning in a rare case of hyperfunctional bilateral adrenocortical carcinoma and review of literatures. World J Nucl Med 2020; 19:301-305. [PMID: 33354192 PMCID: PMC7745877 DOI: 10.4103/wjnm.wjnm_86_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/10/2020] [Indexed: 11/13/2022] Open
Abstract
Adrenal cortical carcinoma (ACC) is a rare aggressive endocrine tumor with poor prognosis. About 60% of ACC are functional tumors. Bilateral ACC is extremely rare, roughly 2%–10% of cases. Diagnosis and staging of ACC by imaging modalities are crucial for preoperative planning and prognostication. Detection of hyperfunctional bilateral adrenocortical carcinoma by 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F- FDG PET/CT) has never been reported. Herein, we report a male patient who presented with Cushing's syndrome, type II diabetes mellitus due to Cushing's syndrome, and hypogonadism with biopsy confirmed left ACC. He underwent 18F-FDG PET/CT to evaluate the contralateral adrenal mass and to plan for laparoscopic adrenalectomy, which subsequently confirmed bilateral ACC. Furthermore, 18F-FDG PET/CT was useful in staging, which revealed paraaortic lymph node and lung metastasis.
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Affiliation(s)
- Apichaya Claimon
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ngoentra Tantranont
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Torpong Claimon
- Department of Radiology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Ohashi K, Hayashi T, Sakamoto M, Iuchi H, Suzuki H, Ebisawa T, Tojo K, Sasano H, Utsunomiya K. Aldosterone-producing adrenocortical carcinoma with prominent hepatic metastasis diagnosed by liver biopsy: a case report. BMC Endocr Disord 2016; 16:3. [PMID: 26772981 PMCID: PMC4715337 DOI: 10.1186/s12902-016-0083-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 01/08/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Aldosterone-producing adrenocortical carcinoma is a rare malignancy, which is usually diagnosed by histopathological examination of the excised tumor. In inoperable cases, aldosterone-producing ACC diagnosed by immunohistochemical staining of the metastatic tumor for Cytochrome P450 (CYP) 11β has not previously been reported and even in that case staining for adrenocortical-specific adrenal 4 binding protein/steroidogenic factor1 (Ad4BP/SF1) and steroidogenic enzymes has not been reported. CASE PRESENTATION We report the case of a 67-year-old Japanese woman with aldosterone-producing adrenocortical carcinoma. Laboratory findings showed severe hypopotassemia. Endocrinological examination revealed an increased plasma aldosterone concentration and suppressed plasma renin activity. Plasma dehydroepiandrosterone sulfate (DHEA-S) was elevated. Diurnal variation in serum cortisol was lost and administration of 1 mg and 8 mg dexamethasone did not suppress serum cortisol levels. From the 24-h urine collection sample, urine aldosterone and urine cortisol levels were greatly increased. Therefore, autonomous excess production was observed for the three adrenal cortex hormones. Abdominal computed tomography and magnetic resonance imaging showed a right adrenal tumor and a huge liver tumor. Adrenocortical carcinoma with metastatic liver cancer was strongly suggested, however surgery could not be considered due to stage IV disease: the liver tumor was too large and cardiac ultrasonography indicated that her cardiac function was poor. Therefore, a liver biopsy was taken to properly determine the diagnosis. Immunohistochemical stains for Ad4BP/SF1 and steroidogenic enzymes were positive. Ad4BP/SF-1 was originally identified as a steroidogenic, tissue-specific transcription factor implicated in the expression of the steroidogenic CYP gene encoding cytochrome P450s. Hence we could diagnose the patient as having adrenocortical carcinoma with metastatic liver cancer. CONCLUSION This rare case had severe hypopotassemia accompanied with not only increased cortisol and DHEA-S but also aldosterone. We reached the diagnosis of adrenocortical carcinoma with metastatic liver cancer based on positive immunohistochemical staining of Ad4BP/SF1 in the liver biopsy specimen. We have reported the first case of aldosterone-producing adrenocortical carcinoma diagnosed solely by immunohistochemical staining for adrenocortical-specific Ad4BP/SF1 and steroidogenic enzymes in a metastatic liver tumor.
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Affiliation(s)
- Kennosuke Ohashi
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, the Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Takeshi Hayashi
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, the Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Masaya Sakamoto
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, the Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Hiroyuki Iuchi
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, the Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Hirofumi Suzuki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, the Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Takanori Ebisawa
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, the Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Katsuyoshi Tojo
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, the Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Hironobu Sasano
- Department of Pathology, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Kazunori Utsunomiya
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, the Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
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Aldosteronismo primario senil asociado a carcinoma suprarrenal funcionante. Rev Clin Esp 2014; 214:e69-71. [DOI: 10.1016/j.rce.2014.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 02/22/2014] [Accepted: 02/24/2014] [Indexed: 11/18/2022]
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