Akademik Veri Yönetim Sistemi
online endo bridge 2021, Ankara, Türkiye, 21 - 24 Ekim 2021, ss.1
Adrenocortical carcinoma (ACC) is a rare epithelial malignant tumor originating from adrenocortical
cells. ACC can be divided into functional and nonfunctional subtypes. Nonfunctional tumors are
accounting for approximately 40% of cases. Its incidence in the population is 1-2 per million cases per
year in North America. In general, ACC patients have a poor prognosis and high recurrence rate, even
if they actively undergo surgical resection. Ki-67 is a crucial prognostic factor for determining localized
ACC immunohistochemically which if Ki-67>10%, the risk of recurrence increased significantly.
A 74-year-old female patient underwent coronary angiography in February 2021 due to chest pain,
weakness, numbness of the hands and feet, and elevated troponin. There was no abdominal pain,
nausea, and abdominal distension. The patient underwent a series of medical treatments. Despite
quadruple antihypertensive drug therapy (lercanidipine, perindopril indapamide, metoprolol,
doxazosin), resistant hypertension and hypokalemia manifested. The patient was diagnosed with
secondary hypertension and referred to us for further evaluation.
Physical examination: Blood Pressure: 160/100 mmHg. There was no localized bulge in the bilateral
kidney area and no obvious tenderness or rebound pain in the entire abdomen.
Adrenal adenoma accompanied by hypertension and hyperkalemia led to the diagnosis of primary
hyperaldosteronism. Plasma aldosterone and renin activity were (>100 ng/dL) and (<0,001
ng/mL/hour) respectively. Furthermore, PAA/PRA ratio and 1 mg Dexamethason suppression test
results were >1000 and (0,66 ug/dL) respectively. Urine metanephrine (48.14ug/24h) and
normetanephrine (64.67ug/24h) levels were normal. Serum potassium level was 2.8. We added 60
mEq/day potassium to the patient.(Table 1)
Abdominal CT, a compatible appearance with a non-adenoma lesion measured approximately 57x56
mm with an Absolute Washout measured above 60%, and a density of 10 HU, was observed in the left
adrenal gland. Left adrenal gland PET-CT revealed a 57x59 mm hypodense, relatively wellcircumscribed nodular lesion. Detected nodule manifested hypometabolism in the center while
increased peripheral metabolic activity (Suv max:9.1).(Figure 1)
After stabilization of electrolyte imbalance and blood pressure, the patient was referred to general
surgery for adrenalectomy. The pathology result of the patient was reported as adrenocortical
carcinoma (no tumor in the surgical margins). The patient was discharged after stabilizing the blood
pressure and electrolyte after one week.(Figure 2