Adrenal cortical carcinoma with late pulmonary metastases causing clinicical Cushing's syndrome: Case report with immunohistochemical analysis of steriodogenic enzyme production Journal Article

  

Authors:	Brutsaert, E. F.; Sasano, H.; Unger, P.; Beasley, M. B.; Golden, B. K.; Inabnet, W. B.; Levine, A. C.
Article Title:	Adrenal cortical carcinoma with late pulmonary metastases causing clinicical Cushing's syndrome: Case report with immunohistochemical analysis of steriodogenic enzyme production
Abstract:	Objective: To present a case of pulmonary metastases from adrenocortical carcinomas (ACC) that were secreting fully-functional cortisol resulting in clinical Cushing's syndrome and to compare the steroidogenic enzyme expression in the primary tumor and lung. Methods: We analyzed and summarized the patient's medical history, physical examination results, laboratory data, imaging studies, and histopathologic results. The original tumor and the pulmonary metastases were then immunohistochemically evaluated for steroidogenic enzymes. Results: Initial endocrinological workup revealed hyperandrogenism and adrenocorticotropic hormone (ACTH) independent Cushing's due to a 4 cm left adrenal mass. The patient was initially diagnosed with an adrenal adenoma. Four years later, the patient developed recurrent Cushing's syndrome. Repeat magnetic resonance imaging (MRI) showed no adrenal masses; however, chest computed tomography (CT) showed multiple bilateral lung nodules and biopsy revealed metastases of adrenal origin. Upon immunohistochemical analysis, side chain cleavage, 17α hydroxylase, 3β hydroxysteroid dehydrogenase, and 21 hydroxylase immunoreactivity were detected in both the original and pulmonary metastatic lesions with patterns of disorganized steroidogenesis. Dehydroepiandrosterone-sulfotransferase (DHEA-ST) immunoreactivity was detected in the original tumor but not in the lung metastases. Conclusion: This case demonstrates some interesting features of ACC that pose challenges to its management, including the difficulties in establishing the pathologic diagnosis, the potential for fully functional steroidogenesis even in late metastases, and the plasticity of steroidogenic potential in tumor cells. Copyright © 2012 AACE.
Journal Title:	Endocrine Practice
Volume:	18
Issue:	6
ISSN:	1530-891X
Publisher:	American Association of Clinical Endocrinologists
Date Published:	2012-11-01
Start Page:	e138
End Page:	e143
Language:	English
DOI:	10.4158/ep12018.cr
PROVIDER:	scopus
PUBMED:	22784838
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84871394818&partnerID=40&md5=4492c89dd62cf5d5fc7eae39ffd61ba3
Notes:	--- - "Export Date: 2 January 2013" - "CODEN: EPNRA" - "Source: Scopus"

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