Hypoglycemia by adrenocortical carcinoma with Cushing's syndrome

A case of adrenocortical carcinoma, a 18-year-old female with Cushing's syndrome and later hypoglycemia, was reported. Cushing's syndrome was corroborated by clinical signs of moon face, obesity, hirsutism and amenorrhea as well as by elevated urinary steroid levels. A huge tumor in the right adrenal region weighing 171 g was removed and histologically diagnosed as adrenocortical carcinoma. Shortly after the surgery, urinary levels of steroid excretion became within normal ranges. However, hypoglycemia with elevated levels of urinary steroid appeared in 6 months postoperatively. She died of massive hemorrhage from gastric ulcer. Autopsy revealed a huge tumor in the right hypochondrial region pressing the liver and right kidney. Tumor cells of autopsy material showed much more anaplastic feature than those of surgical one. Several possible mechanisms for hypoglycemia were discussed.