Feminizing Adrenocortical Carcinomas in a Postmenopausal Woman

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 1-36-Adrenal Incidentaloma & Carcinoma
Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-30
Naga Nalini Tirumalasetty1, Vijayaratna Chockalingam1, Susana Laura Dipp2 and Brandy Ann Panunti*3
1Ochsner Clinic Foundation, New Orleans, LA, 2Ochsner Medical Foundation, New Orleans, LA, 3Ochsner Med Cntr, New Orleans, LA
Introduction:Feminizing adrenocortical carcinomas are rare and detailed reports in women are scarce.  

Case report:A previously healthy 56-yr-old postmenopausal (PM) patient presented to her gynecologist with vaginal bleeding two years after menopause. She had two endometrial biopsies which were normal and was scheduled for a dilatation and curettage but it was cancelled due to a blood pressure of 200/100 mm of Hg. The newly diagnosed hypertension prompted renal artery imaging. Renal ultrasound revealed a right adrenal mass and CT confirmed a vascular 7.9 cm mass with calcifications.  Other symptoms elicited at her first endocrine visit included weight gain, muscle weakness, fatigue, bruising and flushing. On exam she had supraclavicular fullness, plethora and bruising. Hormonal studies revealed 17oh hydroxy progesterone of 664 ng/dl (PM ref 20-172), DHEAS of 282 ug/dl (ref 29-182), estradiol of 101 pg/ml (PM ref < 20)urine 17 ketosteroids of 23.8 mg/d (ref 3.2 -10.6), and urine free cortisol of 215 mcg/d(ref 3.5-45). Based on the high clinical suspicion for adrenocortical carcinoma (ACC) she had an open adrenalectomy. Peri-operatively she was given stress dose steroids. Immediately post operatively her blood pressure normalized and within two weeks the vaginal bleeding stopped. Repeat adrenal and gonadotropin hormonal levels normalized into the post menopausal range.  The histopathological features confirmed the diagnosis of adrenocortical carcinoma using Weiss criteria.  Based on her diagnosis of stage 3 ACC, she was started on mitotane and radiation therapy. Plans are biochemical and radiologic surveillance every three months for the next year.

 Discussion: Feminizing adrenocortical carcinoma is a rare endocrine malignancy. Cases have been reported in men and children but only two in post menopausal women. Vaginal bleeding and new onset hypertension in postmenopausal women should raise the suspicion for adrenal cortical carcinoma.

Nothing to Disclose: NNT, VC, SLD, BAP

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