Development of Cushing's syndrome and virilization after presentation of a nonfunctioning adrenocortical carcinoma

Adrenocortical carcinoma is traditionally divided into functioning and nonfunctioning tumors. However, a case is presented of a 50-year-old woman with a clinically nonfunctioning adrenocortical carcinoma who later developed a Cushingoid appearance and symptoms of virilization with laboratory evidence of marked steroid hormone hypersecretion. The metabolic behavior and the rationale for division of these tumors into two categories (functioning and nonfunctioning) are discussed. It is suggested that such a division may be misleading and may not reflect the true state of the tumors.