Androgen-secreting carcinoma of the adrenal cortex: a case study.

In tumors of the adrenal cortex an endocrine component, responsible for specific clinical symptoms, (Cushing’s syndrome, Conn’s syndrome, and hypersecretion of androgens), may be associated with the purely oncological component (adenomas and carcinomas). The authors describe the case of a 65-year-old woman with hirsutism, hypertension, and diabetes. To evaluate the patient a series of tests was required, including levels of adrenal hormones, (serum and urine cortisol, testosterone, androstenedione, dehydroepiandrosterone sulphate, and 17-OH progesterone), diagnostic imaging, (abdominal ultrasound, abdominal CT scan with contrast material, abdominal MRI without contrast material, and an 18F-FDG-PET total body scan). The hormonal profile revealed elevated levels of adrenal androgens, and an abnormal response to the dexamethasone suppression test, and the presence of urinary free cortisol confirmed the suspicion of an adrenal tumor. The CT scan and MRI identified a arge solid formation, 9 x 6 cm in size, in the right adrenal gland. It was in the axial plane, not clearly separated from segments I, VI, and VII of the liver, nfiltrating the inferior vena cava and the right renal vein, and with dishomogeneous enhancement after contrast material was administered. The total body 18F-FDG-PET scan confirmed that there was a dishomogeneous pattern of hyperactivity. The patient underwent en bloc resection of the right adrenal gland, as well as the right kidney and perirenal fat because the renal vessels had been infiltrated by the tumor. The histology exam confirmed the suspicion of adrenal carcinoma. Hirsutism, associated with increased levels of androgens, can be a sign of an androgen-secreting tumor. Careful evaluation of adrenal function is therefore essential and enables early diagnosis and treatment of tumors that are sometimes very aggressive.