Adrenocortical carcinoma during pregnancy

Area of Science:

• Endocrinology
• Oncology
• Obstetrics & Gynecology

Background:

• Adrenocortical carcinoma (ACC) is a rare malignancy.
• Hypercortisolism in ACC can mimic normal pregnancy symptoms, potentially delaying diagnosis.
• The co-occurrence of ACC and pregnancy is exceptionally rare.

Purpose of the Study:

• To highlight the diagnostic challenges of ACC during pregnancy.
• To review current treatment recommendations based on European and Polish guidelines.
• To present a case study illustrating the complexities of managing ACC in pregnancy.

Main Methods:

• Systematic literature search on PubMed using keywords 'Adrenocortical carcinoma', 'ACC', and 'Pregnancy'.
• Analysis of 12 reported cases of ACC diagnosed during pregnancy, including a case from the authors' institution.
• Review of diagnostic criteria, management strategies, and outcomes for mother and child.

Main Results:

• A 29-year-old pregnant woman diagnosed with ACC at 20/21 weeks gestation underwent surgery.
• Adjuvant therapy was deferred until 32 weeks gestation; delivery via C-section at 31 weeks due to fetal distress.
• Postpartum recurrence of ACC was observed, and despite treatment, the patient died 14 months after diagnosis.

Conclusions:

• Increased vigilance for ACC during pregnancy is essential, recognizing hormonal test differences in pregnant women.
• Higher levels of free plasma cortisol and urinary free cortisol (UFC) are normal in pregnancy, complicating ACC diagnosis.
• Limited therapeutic options for ACC in pregnancy present significant ethical challenges.