She was trapped in a man’s body: a case of Virilizing Adrenocortical carcinoma

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Ralph Jefferon Ramos, Maria Luisa Cecilia Arkoncel, Ryan Joe Dungca and Francis Raymond Arkoncel

JBLMRH, Philippines

: Endocrinol Diabetes Res

Abstract

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Backdround: Adrenocortical carcinoma is a rare malignancy with an annual incidence of 1-2 per million population. Adrenal tumors exclusively secreting androgens are extraordinarily rare most commonly presenting with hirsutism, acne, and clitoromegaly.

Case: A 33 year old female came at the IM-OPD due to amenorrhea for 1 year, accompanied by receeding hairline, mustache, hirsutism more on the hypogastric area and lower extremities, right-sided abdominal pain and deepening of voice, hence, consulted. Prior to onset of symptoms, she was admitted for UTI where KUB ultrasound was requested however, was not done. She was discharged with advice to consult at the OPD, however, was lost to follow up. Upon this consultation, she brought the result with an impression of adrenal mass. Whole Abdominal CT scan was requested and revealed right adrenal mass, 5.6x6.5cm, with downward displacement of the ipsilateral kidney. DHEA-S and TESTOSTERONE were done with elevated results. She was referred to Urosurgery for surgical intervention. She underwent laparoscopic adrenelectomy, right, with finding of right adrenal mass, 8.0x7.0x5.0cm, 80 grams, well circumscribed. On follow up, repeat DHEA-S and TESTOSTERONE were normal. Biopsy showed adrenocortical carcinoma with extracapsular invasion. Three months post-operation, the patient followed up with amenorrhea. She was referred to OB confirming her pregnancy. She has no regular prenatal check-up and is expected to deliver a baby boy on July 17, 2018.

Discussion & Conclusion: Majority of adrenal tumors are metastatic, hence, identification of the origin is important in the diagnosis and managent. History, physical examination, imaging, DHEA-s and Testosterone are the cornerstones in the diagnosis.

Biography

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E-mail: rjramos1987@yahoo.com