An Opportunity Missed: Managing an Aggressive Adrenal Cortical Carcinoma

The document discusses a case of a 42-year-old woman with an aggressive form of Adrenal Cortical Carcinoma (ACC), a rare endocrine tumor. The tumor grew from 4 cm to 17 cm within 4 months, metastasizing to the lung, liver, and left kidney before resection. The patient initially presented with abdominal pain and hypokalemia, and an incidental left adrenal mass was discovered. However, she was lost to follow-up for 3 months. Upon return, the tumor had significantly increased in size and metastasized. Post-operative symptoms included new-onset hirsutism, male-pattern hair loss, proximal muscle weakness, and significant weight loss. The patient declined further therapy for her ACC and died 2 weeks later. The case emphasizes the need for timely and complete biochemical evaluation of adrenal incidentalomas, especially when radiologic features such as size more than 4 cm and heterogeneous appearance are present.