SHM Converge Scientific Abstract ePoster Gallery-Cracking the Cortical Code: Diagnostic Approach for Adrenocortical Carcinoma

Pdf Summary

A 59-year-old woman presented with one month of right upper quadrant abdominal pain and 30-pound unintentional weight loss. Initial labs, including CBC, CMP, and INR, were normal. CT of the chest/abdomen/pelvis revealed a new, large right adrenal mass with invasion into the IVC and liver, and transthoracic echocardiography showed tumor extension into the right atrium.<br /><br />Biochemical evaluation ruled out pheochromocytoma and hyperaldosteronism, but showed elevated free cortisol, total testosterone, and DHEA-S, suggesting a hormonally active adrenal malignancy. Given the tumor burden and vascular/cardiac extension, she was not a candidate for adrenalectomy. Core needle biopsy demonstrated an adrenal cortical neoplasm with extensive necrosis, consistent with adrenocortical carcinoma (ACC), with Ki-67 of 30%.<br /><br />Palliative mitotane and immunotherapy were discussed, but the patient chose comfort-focused care.<br /><br />The case highlights the importance of evaluating incidental adrenal masses with both biochemical testing and imaging features to assess malignancy risk. ACC is rare but highly aggressive, often presenting with hormonal excess, rapid growth, venous invasion, and metastasis. Early recognition is essential because surgical resection offers the best chance for cure, while advanced disease often requires multidisciplinary management and systemic therapy.

Asset Subtitle

Vu D. Nguyen

Meta Tag

Author List An Uche, Maria Louise P. Avenido, Vu D. Nguyen

Category Clinical Vignettes

Concept Adrenocortical Carcinoma

Concept Adrenal Mass

Concept Imaging Finding

Concept Biochemical Evaluation

Concept Clinical Presentation

Distinguished Non-Finalist

Presenter Organization Highland Hospital - Alameda Health System

Presenting Author Vu D. Nguyen

Track Adult

Keywords

adrenocortical carcinoma

adrenal mass

right adrenal tumor

inferior vena cava invasion

right atrial extension

hormonal excess

elevated cortisol

elevated testosterone

Ki-67

mitotane

Adrenocortical Carcinoma

Adrenal Mass

Imaging Finding

Biochemical Evaluation

Clinical Presentation