Abstract

Objective: Our objective is to report a case of isolated dehydroepiandrosterone-sulfate (DHEA-S) secreting adrenocortical carcinoma.

Case Presentation: A 52-year-old African American woman with a medical history of asthma for more than 10 years presented with shortness of breath, chest tightness, and cough. A diagnosis of acute asthma exacerbation with pleuritic chest pain was made, and a CT scan of the chest revealed an incidental left adrenal mass. The patient denied hyperandrogenic symptoms like deepening of the voice, acne, and excessive hair growth. The physical examination was normal, and there was no clitoromegaly. The endocrine workup was significant for increased DHEA-S 766 mcg/dl (15-170 mcg/dl), and the repeat DHEA-S was 829 mcg/dl. All other adrenal hormone levels were within normal limits. The CT scan of the abdomen and pelvis without contrast revealed a 5.5 cm left adrenal mass with Hounsfield units of 23. An open left adrenalectomy was done. Histopathology was reported as marked and diffuse nuclear atypia, necrosis, and atypical mitotic figures. The tumor was strongly positive for inhibin, synaptophysin, and melan-A. The Ki-67 immunostain showed 20-25% positive staining.

Discussion: Adrenocortical carcinoma (ACC) is a rare adrenal cortex malignancy. Both size more than 4 cm and radiographic appearance are significant predictors of malignancy. An isolated DHEA-S secreting ACC patient may have a DHEA-S level more than 3 times the normal upper limit.

Conclusion: Isolated DHEA-S secreting adrenocortical carcinoma patients may present without hyperandrogenic features like hirsutism and virilization.

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Citation

Citation: Vijaya Ganta, MD., et al.. “A Unique Case of Isolated Dehydroepiandrosterone-Sulfate Secreting Adrenocortical Carcinoma: A Case Report with Review of the Literature”.Acta Scientific Medical Sciences 5.11 (2021): 81-85.

Copyright

Copyright: © 2021 Vijaya Ganta, MD., et al.. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.