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A malignant aldosteronoma.

Ann T Sweeney1, Michael A Blake, Leo S Aish

  • 1Department of Medicine, Division of Endocrinology, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02135, USA.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
|July 15, 2004
PubMed
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Adrenocortical carcinoma (ACC) can present as primary aldosteronism. This case highlights the importance of long-term clinical and biochemical surveillance for early detection of metastatic disease.

Area of Science:

  • Endocrinology
  • Oncology
  • Surgical Pathology

Background:

  • Primary aldosteronism is a condition characterized by excessive aldosterone production.
  • Adrenocortical carcinoma (ACC) is a rare malignant tumor of the adrenal cortex.

Observation:

  • A 52-year-old woman presented with hypertension and hypokalemia due to a 6-cm adrenal mass.
  • Biochemical tests showed a high aldosterone-to-renin ratio, indicative of primary aldosteronism.
  • Histologic analysis of the resected tumor was inconclusive regarding its malignant potential.

Findings:

  • Despite initial surgical resection and apparent recovery, the patient developed metastatic ACC nine years later.
  • The case underscores the difficulty in predicting the biologic behavior of some adrenocortical neoplasms.

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  • Metastatic disease manifested as recurrent hypertension and hypokalemia.

    • Implications:

    • Accurate diagnosis of ACC can be challenging, necessitating vigilant long-term follow-up.
    • Comprehensive surveillance including clinical, biochemical, and radiologic assessments is crucial for managing patients with potentially aggressive ACC.
    • Early detection of recurrence or metastasis through diligent monitoring improves treatment outcomes for adrenal cancer.