P2004 - Adrenocortical Carcinoma Presenting as Abdominal Pain

Jefferson Tran, , Chris Alexander, MD, Aaron Cernero, DO, Thomas Tran, MD
TMC, Denison, TX

Introduction: Adrenocortical carcinoma (ACC) is an extremely rare cancer originating in the cortex of the adrenal gland. ACC can lead to hormonal syndromes such as Cushing syndrome, Conn syndrome, pheochromocytoma, masculinization, and feminization. We report a case ACC presenting as abdominal pain.

Case Description/Methods: The patient is a 57-year-old Caucasian male who presented to the GI office with 2 months of abdominal pain in the right lower quadrant with radiation to the left lower quadrant. Pain was crampy, moderate, constant, unrelated to meals. He also had bloating and change of bowel habits with diarrhea and constipation. He had lost 45 lbs. He underwent a colonoscopy which revealed a 6 mm sessile sigmoid hyperplastic polyp which was removed by a snare. The patient had a CT scan that showed a large smooth bordered, homogeneous solid mass in the right adrenal gland suggestive of an adrenal neoplasm. An extensive endocrinology work up showed normal dexamethasone, ACTH, and cortisol (no Cushing syndrome), normal DHEA, testosterone, and estrogen (no masculinization or feminization), normal aldosterone and renin (no Conn syndrome), normal norepinephrine, epinephrine, normetanephrine, metanephrine, and dopamine (no pheochromocytoma). The lesion was initially thought to be a non-functioning adrenal adenoma. The patient underwent a robotic right adrenalectomy which showed a 9.5 cm tumor adhering to the inferior vena cava. Pathology showed tumor invasion through the adrenal capsule into the pericapsular fat. The tumor had < 25% clear cells, 1 mitotic figure per high-power field, Ki-67 < 5%, consistent with a low-grade ACC. Post-operative PET scan showed no recurrence, residual disease, or metastases. Oncology recommended no adjuvant chemotherapy. Proton therapy was started. The patient has done well with no recurrence of symptoms.

Discussion: ACC is a rare tumor with incidence of 1 per million population annually. Patients with ACC should be evaluated for hormonal syndromes such as Cushing syndrome, Conn syndrome, pheochromocytoma, masculinization, and feminization. Treatment is surgical excision of the tumor. Chemotherapy can be considered for surgical non-candidates. Proton therapy has emerged as an effective radiation therapy that minimizes collateral damage to sensitive tissues around the tumor bed. This case shows that abdominal pain presenting to GI can be caused by a non-GI etiology. Cooperation with surgery, endocrinology, oncology, and radiation oncology is crucial in the treatment of ACC.


Disclosures:


Jefferson Tran, , Chris Alexander, MD, Aaron Cernero, DO, Thomas Tran, MD. P2004 - Adrenocortical Carcinoma Presenting as Abdominal Pain, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.