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Liao Z, Gao Y, Zhao Y, Wang Z, Wang X, Zhou J, Zhang Y. Pure androgen-secreting adrenal tumor (PASAT): A rare case report of bilateral PASATs and a systematic review. Front Endocrinol (Lausanne) 2023; 14:1138114. [PMID: 37033242 PMCID: PMC10075358 DOI: 10.3389/fendo.2023.1138114] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/01/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Adult pure androgen-secreting adrenal tumors (PASATs) are extremely rare, and their characteristics are largely unknown. METHODS A rare case of adult bilateral PASATs was reported, and a systematic literature review of adult PASATs was conducted to summarize the characteristics of PASATs. RESULTS In total, 48 studies, including 40 case reports and 8 articles, were identified in this review. Analysis based on data of 42 patients (including current case and 41 patients from 40 case reports) showed that average age was 40.48 ± 15.80 years (range of 18-76). The incidence of adult PASAT peaked at 21-30 years old, while that of malignant PASAT peaked at 41-50 years old. Most PASAT patients were female (40/42, 95.23%), and hirsutism was the most common symptom (37/39, 94.87%). Testosterone (T) was the most commonly elevated androgen (36/42, 85.71%), and 26 of 32 tested patients presented increased dehydroepiandrosterone sulfate (DS) levels. In malignancy cases, disease duration was significantly decreased (1.96 vs. 4.51 years, P=0.025), and tumor diameter was significantly increased (8.9 vs. 4.9 cm, p=0.011). Moreover, the androgen levels, namely, T/upper normal range limit (UNRL) (11.94 vs. 4.943, P=0.770) and DS/UNRL (16.5 vs. 5.28, P=0.625), were higher in patients with malignancy. In total, 5 out of 7 patients showed an increase in DS or T in the human chorionic gonadotropin (HCG) stimulation test. Overall, 41 out of 42 patients (including current case) underwent adrenal surgery, and recurrence, metastasis, or death was reported in 5 out of 11 malignant patients even with adjuvant or rescue mitotane chemotherapy. CONCLUSION Adult PASAT, which is predominant in women, is characterized by virilism and menstrual dysfunction, especially hirsutism. Elevated T and DS may contribute to the diagnosis of adult PASAT, and HCG stimulation test might also be of help in diagnosis. Patients with malignant PASAT have a shorter disease duration, larger tumor sizes and relatively higher androgen levels. Surgery is recommended for all local PASATs, and Malignancy of PASAT should be fully considered due to the high risk of malignancy, poor prognosis and limited effective approaches.
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Affiliation(s)
- Zhangcheng Liao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yuting Gao
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yang Zhao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhan Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xu Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jiaquan Zhou
- Department of Urology, Hainan General Hospital, Haikou, China
| | - Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Yushi Zhang,
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Dogra S, Ahuja A, Bhardwaj M, Sardana R, Goel H. Giant virilising adrenal cortical carcinoma. Autops Case Rep 2021; 11:e2021259. [PMID: 34307221 PMCID: PMC8214900 DOI: 10.4322/acr.2021.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
Abstract
Androgen secreting adrenocortical carcinoma (ACC) is a very rare disease with a poor prognosis. Approximately 80% of tumors are functional, most commonly secreting glucocorticoids. We herewith report a case of a huge functional ACC of the right adrenal gland in a 33-year-old female who presented with complaints of hirsutism, amenorrhea and an abdominal lump. On abdominal examination a large lump was palpable in the right hypochondrium reaching up to the umbilicus. Contrast-enhance computed tomography (CECT) revealed a mass in the right suprarenal region. The tumor measured 29 cm × 20 cm × 12 cm and weighed 7.8 kg, the largest reported case of ACC in the world to the best of our knowledge.
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Affiliation(s)
- Shruti Dogra
- Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Arvind Ahuja
- Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Minakshi Bhardwaj
- Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Rohan Sardana
- Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Hemant Goel
- Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, India
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Costache MF, Arhirii RE, Mogos SJ, Lupascu-Ursulescu C, Litcanu CI, Ciumanghel AI, Cucu C, Ghiciuc CM, Petris AO, Danila N. Giant androgen-producing adrenocortical carcinoma with atrial flutter: A case report and review of the literature. World J Clin Cases 2021; 9:5575-5587. [PMID: 34307612 PMCID: PMC8281402 DOI: 10.12998/wjcc.v9.i20.5575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/24/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adrenocortical carcinoma (ACC), the second most aggressive malignant tumor, lacks epidemiological data worldwide; therefore, every new case can improve the understanding of the pathology and treatment of this malignancy.
CASE SUMMARY We present the case of a 66-year-old Caucasian woman with a giant androgen-producing ACC (21 cm × 17 cm × 12 cm; 2100 g), without metastases, which unusually presented with an acute onset of atrial flutter and congestive heart failure. The cardiac complications observed in our case support the hypothesis that androgen excess in women is a cardiovascular risk factor. Androgen excess in women can be a rare cause of reversible dilated cardiomyopathy, therefore a comprehensive approach to the patient is essential to improve the recognition of androgen-secreting ACC. The atrial flutter was remitted after initiation of drug treatment during admission. The severe heart failure was totally remitted at 6 mo after radical open surgery to remove the giant ACC.
CONCLUSION Radical open surgery to remove a giant androgen-producing ACC was the first-line treatment to cure the excess of androgen, which determined the total remission of cardiac complications at 6 mo after surgery in the women of this case report.
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Affiliation(s)
- Mircea-Florin Costache
- Surgery Clinic, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
| | - Raluca-Elena Arhirii
- Cardiology Clinic, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
| | - Simona-Juliette Mogos
- Department of Endocrinology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
- Endocrinology Clinic, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
| | - Corina Lupascu-Ursulescu
- Department of Radiology and Imaging Sciences, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
- Radiology Clinic, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
| | | | - Adi-Ionut Ciumanghel
- Anesthesia and Intensive Care Department, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
- Anesthesia and Intensive Care Department, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
| | - Catalina Cucu
- Histopatology Department, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
| | - Cristina-Mihaela Ghiciuc
- Department of Pharmacology, Clinical Pharmacology and Algesiology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Antoniu-Octavian Petris
- Cardiology Clinic, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
- Department of Cardiology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Nicolae Danila
- Surgery Clinic, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
- Surgery Clinic, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
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Mantzoros I, Bitsianis S, Loutzidou L, Ntampakis G, Chatzakis C, Christidis P, Gkiouliava A, Koraki E, Aggelopoulos S. Giant Adrenocortical Carcinoma: A Case Report and Review of the Relevant Literature. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928875. [PMID: 33813589 PMCID: PMC8033218 DOI: 10.12659/ajcr.928875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/24/2021] [Accepted: 02/02/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Adrenocortical carcinomas are rare and aggressive tumors often diagnosed as incidentalomas. The malignancy can present with abnormal hormone secretion or the tumor may be non-functioning and present as a palpable mass causing discomfort. Here, we present a case of an adrenal cortical carcinoma originally identified as an incidentaloma. CASE REPORT A 63-year-old woman presented with abdominal pain and discomfort. A large abdominal mass, occupying the left upper and lower quadrant, was palpated. Imaging revealed a mass occupying the left abdomen between the stomach and the spleen, applying pressure on the pylorus, duodenum, splenic vessels, and pancreas. The mass size was 21.2×13×14.6 cm. Hormonal investigations were normal. Surgical exploration was performed, and the tumor was excised. Pathological analysis revealed an adrenocortical carcinoma and the patient underwent adjuvant chemotherapy. Twelve months later, the carcinoma recurred. The patient underwent a second operation in which the recurrent mass was excised along with the tail of the pancreas and a small part of the left lobe of the liver. The postoperative period was uneventful, and the patient was discharged home on the 7th postoperative day. No further adjuvant therapy was applied. The patient remains disease-free 18 months after the reoperation. CONCLUSIONS Giant adrenocortical carcinomas, although rare, pose a challenge to the surgical team both diagnostically and therapeutically. Surgical excision with the appropriate oncologic support can guarantee excellent outcomes.
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Affiliation(s)
- Ioannis Mantzoros
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Stefanos Bitsianis
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Lydia Loutzidou
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Georgios Ntampakis
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Christos Chatzakis
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Panagiotis Christidis
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Anna Gkiouliava
- Department of Anesthesiology, General Hospital of Thessaloniki “G. Papanikolaou”, Exochi, Thessaloniki, Greece
| | - Eleni Koraki
- Department of Anesthesiology, General Hospital of Thessaloniki “G. Papanikolaou”, Exochi, Thessaloniki, Greece
| | - Stamatios Aggelopoulos
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
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Lam AKY. Adrenocortical Carcinoma: Updates of Clinical and Pathological Features after Renewed World Health Organisation Classification and Pathology Staging. Biomedicines 2021; 9:biomedicines9020175. [PMID: 33578929 PMCID: PMC7916702 DOI: 10.3390/biomedicines9020175] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 12/20/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a heterogenous group of diseases with different clinical behaviour between adult and paediatric patients. In addition, three histological variants, oncocytic, myxoid and sarcomatoid are noted on the recent World Health Organisation (WHO) classification of ACC. A review of recent literature showed that the different types of ACC have distinctive demographic data, clinical presentation, pathology, biological behaviour, genomic and patients' prognosis. In addition, recent updates of pathology staging for ACC allow refinement of prognostic grouping for planning treatment of the patients with ACC. These advances in genomic, pathology and staging have driven the development of standardisation of pathology reporting. International standardisation of pathological reporting of adrenocortical carcinoma and adaption to local pathology communities provide universal platforms for clinicians and researchers involved in the management of patients with ACC. To conclude, all these advances in the field of pathology will improve development of management strategies including improvement of clinical care, development of prognostic markers and testing of novel therapeutic approaches for patients with adrenocortical carcinoma.
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Affiliation(s)
- Alfred King-yin Lam
- School of Medicine, Griffith University, Gold Coast, QLD 4222, Australia;
- Pathology Queensland, Gold Coast University Hospital, Southport, Gold Coast, QLD 4215, Australia
- Faculty of Medicine, The University of Queensland, Herston, Brisbane, QLD 4006, Australia
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