Adrenocortical carcinoma: an ominous cause of hirsutism
Hirsutism is a common medical presentation to family physicians, internists and endocrinologists. Although the cause is commonly benign, a more serious or life-threatening one should not be missed. Here we report a 58-year-old woman, assessed for hirsutism and 15-pound weight gain, with associated e...
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| Veröffentlicht in: | BMJ case reports 2019-12, Vol.12 (12), p.e232547 |
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| description | Hirsutism is a common medical presentation to family physicians, internists and endocrinologists. Although the cause is commonly benign, a more serious or life-threatening one should not be missed. Here we report a 58-year-old woman, assessed for hirsutism and 15-pound weight gain, with associated easy bruising and mood swings. On physical examination, she was hypertensive with central obesity. Laboratory work was significant for erythrocytosis, leukocytosis with lymphopenia and transaminitis. With this initial clinical picture, a provisional diagnosis of cortisol and androgen hypersecretion was suspected. Further investigations revealed non-suppressible early morning cortisol after low-dose dexamethasone, elevated 24 hours urinary-free cortisol and late night salivary cortisol. In addition, serum adrenocorticotropin hormone was low and androgens were elevated. These results supported the provisional diagnosis and imaging of the adrenals showed a large 10.4×7.7×5.2 cm right adrenal mass, consistent with adrenocortical carcinoma, for which she underwent surgical resection. |
| doi_str_mv | 10.1136/bcr-2019-232547 |
| format | Article |
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Although the cause is commonly benign, a more serious or life-threatening one should not be missed. Here we report a 58-year-old woman, assessed for hirsutism and 15-pound weight gain, with associated easy bruising and mood swings. On physical examination, she was hypertensive with central obesity. Laboratory work was significant for erythrocytosis, leukocytosis with lymphopenia and transaminitis. With this initial clinical picture, a provisional diagnosis of cortisol and androgen hypersecretion was suspected. Further investigations revealed non-suppressible early morning cortisol after low-dose dexamethasone, elevated 24 hours urinary-free cortisol and late night salivary cortisol. In addition, serum adrenocorticotropin hormone was low and androgens were elevated. These results supported the provisional diagnosis and imaging of the adrenals showed a large 10.4×7.7×5.2 cm right adrenal mass, consistent with adrenocortical carcinoma, for which she underwent surgical resection.</description><identifier>ISSN: 1757-790X</identifier><identifier>EISSN: 1757-790X</identifier><identifier>DOI: 10.1136/bcr-2019-232547</identifier><identifier>PMID: 31892624</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Abdomen ; Acne ; Adrenal Cortex Neoplasms - complications ; Adrenal Cortex Neoplasms - diagnosis ; Adrenal Cortex Neoplasms - diagnostic imaging ; Adrenal Cortex Neoplasms - surgery ; Adrenal glands ; Adrenocortical Carcinoma - complications ; Adrenocortical Carcinoma - diagnosis ; Adrenocortical Carcinoma - diagnostic imaging ; Adrenocortical Carcinoma - surgery ; Androgens ; Blood pressure ; Case reports ; Diagnosis, Differential ; Drug dosages ; Family medical history ; Female ; Hair ; Hemoglobin ; Hirsutism - etiology ; Hormones ; Humans ; Hypertension ; Liver ; Magnetic Resonance Imaging ; Middle Aged ; Neuroendocrine tumors ; Polycystic ovary syndrome ; Rare Disease ; Skin ; Surgery ; Testosterone ; Womens health</subject><ispartof>BMJ case reports, 2019-12, Vol.12 (12), p.e232547</ispartof><rights>BMJ Publishing Group Limited 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2019 BMJ Publishing Group Limited 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>BMJ Publishing Group Limited 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-b410t-bf79b328ef0646fa6fbb7802c7959b2df1455e05afdf30856489d0a08ffe17b13</cites><orcidid>0000-0002-2785-9398</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954802/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954802/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31892624$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Radi, Suhaib</creatorcontrib><creatorcontrib>Tamilia, Michael</creatorcontrib><title>Adrenocortical carcinoma: an ominous cause of hirsutism</title><title>BMJ case reports</title><addtitle>BMJ Case Rep</addtitle><description>Hirsutism is a common medical presentation to family physicians, internists and endocrinologists. Although the cause is commonly benign, a more serious or life-threatening one should not be missed. Here we report a 58-year-old woman, assessed for hirsutism and 15-pound weight gain, with associated easy bruising and mood swings. On physical examination, she was hypertensive with central obesity. Laboratory work was significant for erythrocytosis, leukocytosis with lymphopenia and transaminitis. With this initial clinical picture, a provisional diagnosis of cortisol and androgen hypersecretion was suspected. Further investigations revealed non-suppressible early morning cortisol after low-dose dexamethasone, elevated 24 hours urinary-free cortisol and late night salivary cortisol. In addition, serum adrenocorticotropin hormone was low and androgens were elevated. These results supported the provisional diagnosis and imaging of the adrenals showed a large 10.4×7.7×5.2 cm right adrenal mass, consistent with adrenocortical carcinoma, for which she underwent surgical resection.</description><subject>Abdomen</subject><subject>Acne</subject><subject>Adrenal Cortex Neoplasms - complications</subject><subject>Adrenal Cortex Neoplasms - diagnosis</subject><subject>Adrenal Cortex Neoplasms - diagnostic imaging</subject><subject>Adrenal Cortex Neoplasms - surgery</subject><subject>Adrenal glands</subject><subject>Adrenocortical Carcinoma - complications</subject><subject>Adrenocortical Carcinoma - diagnosis</subject><subject>Adrenocortical Carcinoma - diagnostic imaging</subject><subject>Adrenocortical Carcinoma - surgery</subject><subject>Androgens</subject><subject>Blood pressure</subject><subject>Case reports</subject><subject>Diagnosis, Differential</subject><subject>Drug dosages</subject><subject>Family medical history</subject><subject>Female</subject><subject>Hair</subject><subject>Hemoglobin</subject><subject>Hirsutism - etiology</subject><subject>Hormones</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Liver</subject><subject>Magnetic Resonance Imaging</subject><subject>Middle Aged</subject><subject>Neuroendocrine tumors</subject><subject>Polycystic ovary syndrome</subject><subject>Rare Disease</subject><subject>Skin</subject><subject>Surgery</subject><subject>Testosterone</subject><subject>Womens health</subject><issn>1757-790X</issn><issn>1757-790X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkUtLAzEUhYMotmjX7mTAjQhj85xMXAhSfEHBjYK7kGQSO2VmUpMZwX9vSqtUN2ZzL7lfzs3hAHCC4CVCpJhqE3IMkcgxwYzyPTBGnPGcC_i6v9OPwCTGJUyHIFpScghGBJUCF5iOAb-pgu288aGvjWoyo4KpO9-qq0x1mW9TP8R0O0SbeZct6hCHvo7tMThwqol2sq1H4OXu9nn2kM-f7h9nN_NcUwT7XDsuNMGldbCghVOF05qXEBsumNC4cogyZiFTrnIElqygpaiggqVzFnGNyBG43uiuBt3aytiuD6qRq1C3KnxKr2r5e9LVC_nmP2QhGE2LksD5ViD498HGXrZ1NLZpVGeTNYkJQVwIiNa7zv6gSz-ELtlLFC0xYZDyRE03lAk-xmDdz2cQlOtcZMpFrnORm1zSi9NdDz_8dwoJuNgAul3-q_YFRjOV5Q</recordid><startdate>20191230</startdate><enddate>20191230</enddate><creator>Radi, Suhaib</creator><creator>Tamilia, Michael</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2785-9398</orcidid></search><sort><creationdate>20191230</creationdate><title>Adrenocortical carcinoma: an ominous cause of hirsutism</title><author>Radi, Suhaib ; Tamilia, Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b410t-bf79b328ef0646fa6fbb7802c7959b2df1455e05afdf30856489d0a08ffe17b13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Abdomen</topic><topic>Acne</topic><topic>Adrenal Cortex Neoplasms - complications</topic><topic>Adrenal Cortex Neoplasms - diagnosis</topic><topic>Adrenal Cortex Neoplasms - diagnostic imaging</topic><topic>Adrenal Cortex Neoplasms - surgery</topic><topic>Adrenal glands</topic><topic>Adrenocortical Carcinoma - complications</topic><topic>Adrenocortical Carcinoma - diagnosis</topic><topic>Adrenocortical Carcinoma - diagnostic imaging</topic><topic>Adrenocortical Carcinoma - surgery</topic><topic>Androgens</topic><topic>Blood pressure</topic><topic>Case reports</topic><topic>Diagnosis, Differential</topic><topic>Drug dosages</topic><topic>Family medical history</topic><topic>Female</topic><topic>Hair</topic><topic>Hemoglobin</topic><topic>Hirsutism - etiology</topic><topic>Hormones</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Liver</topic><topic>Magnetic Resonance Imaging</topic><topic>Middle Aged</topic><topic>Neuroendocrine tumors</topic><topic>Polycystic ovary syndrome</topic><topic>Rare Disease</topic><topic>Skin</topic><topic>Surgery</topic><topic>Testosterone</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Radi, Suhaib</creatorcontrib><creatorcontrib>Tamilia, Michael</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ case reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Radi, Suhaib</au><au>Tamilia, Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adrenocortical carcinoma: an ominous cause of hirsutism</atitle><jtitle>BMJ case reports</jtitle><addtitle>BMJ Case Rep</addtitle><date>2019-12-30</date><risdate>2019</risdate><volume>12</volume><issue>12</issue><spage>e232547</spage><pages>e232547-</pages><issn>1757-790X</issn><eissn>1757-790X</eissn><abstract>Hirsutism is a common medical presentation to family physicians, internists and endocrinologists. Although the cause is commonly benign, a more serious or life-threatening one should not be missed. Here we report a 58-year-old woman, assessed for hirsutism and 15-pound weight gain, with associated easy bruising and mood swings. On physical examination, she was hypertensive with central obesity. Laboratory work was significant for erythrocytosis, leukocytosis with lymphopenia and transaminitis. With this initial clinical picture, a provisional diagnosis of cortisol and androgen hypersecretion was suspected. Further investigations revealed non-suppressible early morning cortisol after low-dose dexamethasone, elevated 24 hours urinary-free cortisol and late night salivary cortisol. In addition, serum adrenocorticotropin hormone was low and androgens were elevated. These results supported the provisional diagnosis and imaging of the adrenals showed a large 10.4×7.7×5.2 cm right adrenal mass, consistent with adrenocortical carcinoma, for which she underwent surgical resection.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>31892624</pmid><doi>10.1136/bcr-2019-232547</doi><orcidid>https://orcid.org/0000-0002-2785-9398</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Abdomen Acne Adrenal Cortex Neoplasms - complications Adrenal Cortex Neoplasms - diagnosis Adrenal Cortex Neoplasms - diagnostic imaging Adrenal Cortex Neoplasms - surgery Adrenal glands Adrenocortical Carcinoma - complications Adrenocortical Carcinoma - diagnosis Adrenocortical Carcinoma - diagnostic imaging Adrenocortical Carcinoma - surgery Androgens Blood pressure Case reports Diagnosis, Differential Drug dosages Family medical history Female Hair Hemoglobin Hirsutism - etiology Hormones Humans Hypertension Liver Magnetic Resonance Imaging Middle Aged Neuroendocrine tumors Polycystic ovary syndrome Rare Disease Skin Surgery Testosterone Womens health |
| title | Adrenocortical carcinoma: an ominous cause of hirsutism |
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