Adrenocortical carcinoma, an unusual cause of secondary hypertension

• Published in: BMJ case reports Vol. 2016; p. bcr2016217918
• Main Authors: Veron Esquivel, Daniel, Batiz, Fernando, Farias Vega, Alfonso, Carrillo Gonzalez, Perla A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 07-12-2016; BMJ Publishing Group
• Series: Case Report
• Subjects: Abdomen; Adrenal Cortex Neoplasms - complications; Adrenal Cortex Neoplasms - diagnosis; Adrenocortical Carcinoma - complications; Adrenocortical Carcinoma - diagnosis; Adult; Biopsy; Blood Pressure; Edema; Emergency medical care; Family medical history; Female; Hormones; Humans; Hypertension; Hypertension - diagnosis; Hypertension - etiology; Hypertension - physiopathology; Laboratories; Metabolism; Metastasis; Patients; Plasma; Potassium; South/Central America; Tomography, X-Ray Computed; Tumors; Unusual Presentation of More Common Disease/Injury; Urine; White
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2016-217918

We present the case of a female patient aged 39 years who was admitted to our hospital due to hypertension, severe hypokalaemia and metabolic alkalosis; physical examination was remarkable for plethoric moon face, centripetal obesity and bilateral lower extremity oedema. She was admitted for intravenous potassium replacement and further assessment of hypertension and associated clinical findings. Laboratory testing showed increased levels of aldosterone, renin, cortisol, testosterone and androstenedione. An abdominal CT revealed a large mass in the right adrenal gland with hepatic involvement. The patient was started on antihypertensive medications and underwent laparoscopic surgery for mass and liver biopsy. The pathological diagnosis was adrenocortical carcinoma with liver metastasis. Hyperaldosteronism is a cause of secondary hypertension and its diagnosis is usually benign. Adrenocortical carcinoma is a rare condition and aldosterone secreting tumours are even rarer; associated hypertension usually improves after tumour resection, but with the presence of metastasis, blood pressure control is difficult.