Case of adrenal carcinoma in 27-year-old woman, diagnosed during her first pregnancy.
This article describes the case of a 27-year-old primigravid woman who presented to the hospital with new-onset diabetes and hypertension. She was in her 32nd week of gestation and complained of several months history of proximal muscle weakness, striae and facial plethora. The patient was diagnosed with adrenal carcinoma.
Physical examination was significant of violaceous striae over the abdomen, breasts, dorsal and supraclavicular fat pads. For further evaluation, doctors advised laboratory studies which were significant for decreased potassium levels and normal creatinine ratio. The patient was also advised an ultrasound examination to evaluate her for Cushing’s syndrome. Ultrasound showed a right adrenal mass, measuring 7 cm in length. In addition, the level of cortisol in the urine over 24 hours highly increased.
Doctors prescribed the patient labetalol and nifedipine for management of hypertension.
However, at 34 weeks of gestation the patient developed HELLP syndrome, characterised by hemolysis, elevated liver enzymes and low platelet count. She delivered a healthy infant weighing 2890 g. She further underwent a computed tomography scan with contrast material which showed an adrenal mass measuring 6.8 cm. The finding led to the diagnosis of an adrenal carcinoma.
Treatment included adrenalectomy 1 month after her delivery. Histopathological analysis of the biopsied mass confirmed the presence of a high-grade adrenocortical carcinoma. Fortunately, the cancer had not metastasised and the patient was put on treatment with adjuvant mitotane.
References
Striae and an Adrenal Mass https://www.nejm.org/doi/full/10.1056/NEJMicm2024730
