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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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Autores principales: Radi, Suhaib, Tamilia, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954802/
https://www.ncbi.nlm.nih.gov/pubmed/31892624
http://dx.doi.org/10.1136/bcr-2019-232547
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author Radi, Suhaib
Tamilia, Michael
author_facet Radi, Suhaib
Tamilia, Michael
author_sort Radi, Suhaib
collection PubMed
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.
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spelling pubmed-69548022020-01-23 Adrenocortical carcinoma: an ominous cause of hirsutism Radi, Suhaib Tamilia, Michael BMJ Case Rep Rare Disease 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. BMJ Publishing Group 2019-12-30 /pmc/articles/PMC6954802/ /pubmed/31892624 http://dx.doi.org/10.1136/bcr-2019-232547 Text en © 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/.
spellingShingle Rare Disease
Radi, Suhaib
Tamilia, Michael
Adrenocortical carcinoma: an ominous cause of hirsutism
title Adrenocortical carcinoma: an ominous cause of hirsutism
title_full Adrenocortical carcinoma: an ominous cause of hirsutism
title_fullStr Adrenocortical carcinoma: an ominous cause of hirsutism
title_full_unstemmed Adrenocortical carcinoma: an ominous cause of hirsutism
title_short Adrenocortical carcinoma: an ominous cause of hirsutism
title_sort adrenocortical carcinoma: an ominous cause of hirsutism
topic Rare Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954802/
https://www.ncbi.nlm.nih.gov/pubmed/31892624
http://dx.doi.org/10.1136/bcr-2019-232547
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