adrenal cortical adenocarcinoma

Adrenal cortical adenocarcinoma, also known as adrenocortical carcinoma, is a rare type of cancer that affects the outer layer (cortex) of the adrenal gland. The symptoms of this condition can vary from person to person, but here are some common signs and symptoms:

• Weight gain or loss: Some people may experience unexplained weight gain or loss due to hormonal changes caused by the tumor.
• High blood pressure: Elevated blood pressure is a common symptom of adrenocortical carcinoma, as the tumor can produce excess hormones that affect blood pressure regulation.
• Muscle weakness and fatigue: Muscle weakness and fatigue are also possible symptoms, especially if the tumor presses against nearby organs or disrupts hormone production.
• Hormonal changes: The tumor can cause hormonal imbalances, leading to symptoms such as:
  • Excess facial and body hair in women (hirsutism)
  • Breast tenderness or enlargement in men
  • High blood sugar fluctuations
  • Bruising or bleeding easily
• Abdominal pain: Pain in the abdomen or lower back can occur if the tumor grows and presses against nearby organs.
• A lump in the abdomen: A palpable lump may be felt in the abdominal area, especially if the tumor is large.
• Feeling of fullness: Some people may experience a feeling of fullness in the abdomen, even after eating small amounts.

It's essential to note that not everyone with adrenocortical carcinoma will exhibit all of these symptoms. The severity and type of symptoms can vary depending on the size and location of the tumor, as well as individual factors.

References:

• [1] Excessive hair growth on the face and body (such as in the pubic and underarm areas) is a common symptom of adrenocortical carcinoma.
• [2-4] Weight gain, muscle weakness, trouble sleeping, deepening voice, and increased hair growth are also possible symptoms.
• [5-7] Abdominal pain, back pain, feeling of fullness in the abdomen, high blood pressure, high blood sugar, and hormonal changes are other common symptoms.
• [8-10] A lump in the abdomen, pain in the abdomen or back, a feeling of fullness in the abdomen, and unexplained weight gain or loss are also possible symptoms.

Diagnostic Tests for Adrenal Cortical Carcinoma

Adrenal cortical carcinoma, a rare and aggressive cancer, can be diagnosed using various tests and procedures. The following diagnostic tests are commonly used to detect and confirm the presence of this disease:

• Blood and Urine Tests: Laboratory tests of blood and urine may reveal unusual levels of hormones produced by the adrenal glands, including cortisol, aldosterone, and androgens [3]. Elevated hormone levels can indicate the presence of adrenal cortical carcinoma.
• Imaging Tests: Imaging studies such as CT scans, MRI, and ultrasounds are used to visually examine the adrenal gland and detect any abnormalities [7][9]. These tests can help identify tumors or other changes in the adrenal gland that may be indicative of cancer.
• 24-hour Urinary Free Cortisol Test: This test measures cortisol levels in urine over a 24-hour period, which can indicate abnormal cortisol production by an adrenal tumor [1].
• Midnight Salivary Cortisol Test: This test measures cortisol levels in saliva at midnight, which can help diagnose hypercortisolism and confirm the presence of adrenal cortical carcinoma [11].
• Dexamethasone Suppression Test (DST): This test involves administering a low dose of dexamethasone to suppress cortisol production. Elevated cortisol levels after this test can indicate adrenal cortical carcinoma [11].

These diagnostic tests are used in combination with each other and with clinical evaluation to confirm the presence of adrenal cortical carcinoma.

References

[1] The levels of cortisol are measured in the urine, saliva, and blood. If an adrenal tumor is making cortisol, these levels will be abnormally high. For urine tests, you may be asked to collect all your urine for 24 hours. This is called a 24-hour urinary free cortisol test.

[3] Diagnosis. Tests and procedures used to diagnose adrenal cancer include: Blood and urine tests. Laboratory tests of your blood and urine may reveal unusual levels of hormones produced by the adrenal glands, including cortisol, aldosterone and androgens.

[7] Adrenal gland cancer can be diagnosed or ruled out by tests such as blood chemistry tests, a CT scan and an MRI.

[9] Imaging scans, including CT scans and ultrasounds, to visually examine a patient's adrenal gland; Blood and urine tests to check for elevated hormone levels. If ...

[11] Cortisol hyperproduction causes suppressed ACTH (<10 pg/mL) and increased morning cortisol levels. The diagnosis of hypercortisolism is usually established by a 1-mg dexamethasone suppression test (1-mg DST), midnight salivary cortisol, or elevated 24-h urine free cortisol [].Autonomic cortisol secretion is confirmed for cortisol levels above 5 µg/dL after 1-mg DST, whereas a value < 1.8 µg ...

Treatment Options for Adrenal Cortical Carcinoma

Adrenal cortical carcinoma (ACC) is a rare and aggressive cancer that requires prompt and effective treatment. While surgery remains the primary treatment option, drug therapy plays a crucial role in managing this disease.

Systemic Therapy

For patients with advanced or metastatic ACC, systemic therapy is often recommended. The most commonly used drugs for treating ACC include:

• Mitotane: This medication is typically taken orally and has been shown to be effective in reducing tumor size and alleviating symptoms [8][9]. Mitotane can have side effects, but its benefits often outweigh the risks.
• Chemotherapy: Chemotherapy agents such as doxorubicin, cisplatin, or etoposide may be used to treat ACC that has spread to other parts of the body [7].

Adjuvant Therapy

For patients who undergo surgery for stage I to III disease, adjuvant therapy with mitotane may be recommended. Studies have shown that maintaining a serum level of ≥14 mg/L is associated with better overall survival [8]. Adjuvant radiation therapy may also be considered in some cases.

Symptom Control

In addition to systemic therapy, medications can be used to control symptoms caused by high levels of adrenal hormones. For example, drugs like prednisone or dexamethasone may be prescribed to manage Cushing syndrome, a common symptom of ACC [4].

Current Research and Future Directions

Recent studies have focused on the use of mitotane in combination with other agents for treating ACC. Researchers are also exploring new treatment options, such as targeted therapies and immunotherapies.

References:

[7] - Adrenal cortical carcinoma TNM, 8th edition - Ann Arbor modification ENSAT staging ACC ... Initial surgery — Complete surgical resection is the only potentially curative treatment for adrenocortical carcinoma (ACC). For patients with potentially resectable disease, surgery should be performed by a surgeon experienced in adrenal surgery.

[8] Hahner S, Fassnacht M. Mitotane for adrenocortical carcinoma treatment. Curr Opin Investig Drugs. 2005;6(4):386-394.

[9] - Adrenal Cortical Carcinoma—Pathophysiology and Treatment. Adrenocortical carcinoma (ACC) is a rare epithelial neoplasm that originates in the adrenal cortex and has a high propensity to local invasion and distant metastases. An annual incidence of ACC is between 0.7 and 2 cases per million population.

[10] - Drugs used to treat Adrenal Cortical Carcinoma The medications listed below are related to or used in the treatment of this condition. Drug name Rating Reviews Activity ? Rx/OTC Preg nancy CSA ...

The differential diagnosis of adrenal cortical adenocarcinoma (ACA) involves a range of conditions that can mimic the presentation and characteristics of ACA. Some of the key entities to consider in the differential diagnosis include:

• Adrenocortical oncocytoma: A rare, benign tumor of the adrenal cortex that can be difficult to distinguish from ACA based on imaging studies alone [6].
• Pheochromocytoma: A catecholamine-producing tumor of the adrenal medulla that can present with similar symptoms and imaging findings as ACA [3][8].
• Metastatic carcinoma: Tumors originating from other parts of the body, such as the breast or lung, that can metastasize to the adrenal gland and mimic the presentation of ACA [4][8].
• Myelolipoma: A rare, benign tumor of the adrenal gland composed of mature myeloid cells that can be difficult to distinguish from ACA based on imaging studies alone [11].
• Adrenal cysts: Cysts that can occur in the adrenal gland and may be mistaken for ACA or other types of tumors [13].

It's worth noting that the differential diagnosis of ACA requires a comprehensive evaluation of clinical characteristics, pathological morphological features, and various auxiliary investigations to accurately distinguish it from these other entities [12].