Faculty Collaboration Database

Diagnostic challenges in adrenocortical carcinoma: recommendations for surveillance after surgical resection of selected adrenal nodules. Endocr Pract 2007 Oct;13(6):636-41

Date

10/24/2007

Pubmed ID

17954420

DOI

10.4158/EP.13.6.636

Scopus ID

2-s2.0-38449118662 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

OBJECTIVE: To discuss challenges in the diagnosis of adrenocortical carcinoma and to suggest surveillance measures after removal of selected adrenal nodules.

METHODS: We present the case of a 65-year-old man with worsening hypertension and new-onset hypokalemia attributed to primary hyperaldosteronism due to a 3-cm right adrenal nodule.

RESULTS: A laparoscopic right adrenalectomy was performed, and the histologic diagnosis was a benign adenoma. The patient's hypertension and hypokalemia improved postoperatively but recurred 8 months later, and florid Cushing's syndrome developed. Magnetic resonance imaging showed an 8-cm mass in the right adrenal bed and multiple hepatic metastatic lesions. Fine-needle biopsy confirmed the presence of adrenocortical carcinoma.

CONCLUSION: Despite a comprehensive biochemical, radiologic, and histologic assessment, the diagnosis of adrenocortical carcinoma can be missed. Particularly, we caution against undue reliance on the initial tumor size. We recommend that abdominal imaging be performed every 3 months for the first year and every 6 months for the second year after surgical removal of selected adrenal nodules.

Author List

Fareau GG, Vassilopoulou-Sellin R

Author

Gilbert G. Fareau MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adrenal Cortex Neoplasms
Adrenal Glands
Adrenalectomy
Adrenocortical Adenoma
Adrenocortical Carcinoma
Aged
Humans
Hyperaldosteronism
Hypertension
Hypokalemia
Magnetic Resonance Imaging
Male
Treatment Outcome