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Functioning metastasis from adrenocortical carcinoma
  1. Clara Cunha1,
  2. Sara Donato2,
  3. Tiago Silva2 and
  4. Valeriano Leite2,3
  1. 1Endocrinology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
  2. 2Endocrinology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
  3. 3Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
  1. Correspondence to Dr Clara Cunha; cicunha{at}


Recurrence of Cushing’s syndrome due to functional metastasis from adrenocortical carcinoma (ACC) after adrenalectomy is extremely rare. We describe a case of a 56-year-old woman who presented with Cushing’s syndrome due to an ACC. Abdominal CT showed a heterogeneous left adrenal tumour of 8 cm as well as a right adrenal nodule with 3 cm. An 18F-fluorodeoxyglucose positron emission tomography-CT (18F-FDG/CT PET) revealed an increased uptake of both adrenal lesions (maximum standardised uptake values, 17.7 and 10.4 for left and right adrenal lesions, respectively). Patient underwent bilateral adrenalectomy with R0 resection. Pathological examination revealed a left ACC with a Weiss’ score of 7, Ki67 10%, stage II European Network for the Study of Adrenal Tumours and a right adrenal adenoma. After surgery, clinical improvement was noted. Two months later, she noticed recurrence of hypercortisolism and multiple liver and lung metastasis were demonstrable, without evidence of local recurrence on the 18F-FDG/CT PET and abdominal MRI.

  • endocrinology
  • adrenal disorders

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  • Contributors CC drafted the manuscript. SD, TS and VL reviewed and edited the manuscript prior to submission. CC, SD and TS were the physicians who contributed to the care of the patient. VL also performed the final editing of the manuscript and gave the approval to submit the manuscript for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.