Bilateral Adrenocortical Carcinoma Presenting as Acute Adrenal Insufficiency

The presentation of adrenocortical carcinoma (ACC) with bilateral adrenal masses and acute adrenal insufficiency is exceedingly rare and has only been seen in anecdotal case reports. Herein, we describe the case of a 50-year-old male who presented with a painful abdominal lump, loss of weight and appetite, several episodes of vomiting, and hypotension. Imaging studies were suggestive of bilateral adrenal masses and a lung mass. Hormonal work-up was suggestive of acute adrenal insufficiency, with the adrenal masses being non-secretory. An ultrasound-guided biopsy from one of the adrenal masses was suggestive of ACC, thus confirming the diagnosis as bilateral ACC with distant metastases. Bilateral adrenalectomy was planned for the patient, but unfortunately, he succumbed to his disease before the surgery.