Adrenocortical Carcinoma: A Case Report on the Diagnostic and Therapeutic Approach

Although the diagnosis of adrenocortical carcinoma might not be challenging, there is still a lack of evidence on the recommended therapeutic options, the extent of lymph node dissection, and the use of chemotherapy and radiotherapy.This is the case of a 43-year-old man who presented to our department with unregulated blood pressure.During the diagnostic workup, he underwent a CT scan that showed an incidental solid, ovoid 7-cm lesion of the adrenal gland with a density of 30 HU pre-contrast, 60 HU right after, and 38 HU in a 15-min delayed measurement after contrast administration.His plasma metanephrines, dehydroepiandrosterone sulfate (DHEA-S), total and free testosterone, and adrenocorticotropic hormone (ACTH) were normal.While his 8.00 am baseline serum cortisol was also within the age-adjusted reference range, the 8.00 am serum cortisol concentration after an overnight 1-mg dexamethasone suppression test was suppressed.Although the aldosterone-to-renin ratio was found to be elevated, this was attributed to concomitant β-adrenergic blockade due to the biochemical evaluation.The patient underwent an endoscopic retroperitoneal left adrenalectomy.Histological examination revealed an encapsulated adrenocortical carcinoma, with a Ki-67 proliferation index of 21%.The patient was discharged and remains under follow-up with no evidence of recurrence.Adrenocortical carcinomas are classified into stages according to their size, local invasion, and metastatic potential.Surgical excision is the treatment of choice for non-metastasized ACCs, while in cases of metastases, chemotherapy and radiotherapy is usually preferred.This case highlights the need for further research into the pathophysiology of this malignancy to facilitate the development of evidence-based guidelines and to optimize management strategies for advanced-stage disease.