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Published on: September 15, 2017
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Massive adrenocortical carcinoma presenting as peripheral edema: a case report
1, Washington, USA. davidagoodkin@comcast.net.
Journal of Medical Case Reports
|June 20, 2022
Summary
Adrenocortical carcinoma can present unusually with leg edema due to inferior vena cava compression. Early abdominal imaging is crucial for diagnosing this rare but aggressive adrenal cancer.
Area of Science:
- Endocrinology
- Oncology
- Radiology
Background:
- Adrenocortical carcinoma (ACC) is a rare, aggressive malignancy.
- Often diagnosed incidentally or via hormonal symptoms.
- This case highlights an unusual presentation of ACC causing severe leg edema.
Observation:
- A 65-year-old male presented with severe bilateral leg edema and dyspnea.
- Imaging revealed a large adrenal tumor compressing the inferior vena cava.
- Elevated cortisol and dehydroepiandrosterone sulfate confirmed hormonal activity.
Findings:
- Surgical resection of a 27-cm adrenal tumor and associated structures.
- Histopathology confirmed adrenocortical carcinoma with a high Ki67 index.
- Adjuvant mitotane chemotherapy was initiated, requiring hydrocortisone for adrenal suppression.
Implications:
- Unexplained leg edema warrants abdominal imaging to rule out retroperitoneal masses like ACC.
- Advanced ACC stages carry a poor prognosis.
- Mitotane chemotherapy, while standard, has complications and drug interactions (CYP3A4 induction).
