Two heartbeats, one tumor: Non-functioning adrenocortical tumor in pregnancy
https://doi.org/10.15605/jafes.041.S1
- Author:
Nur Nisrina Yahya
1
;
Noor Rafhati Adyani Abdullah
1
Author Information
1. Hospital Sultanah Bahiyah
- Publication Type:Journal Article
- MeSH:
Female;
Pregnancy;
Heart Rate;
Neoplasms
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):21-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Adrenocortical carcinoma (ACC) is a rare and aggressive
malignancy, with an incidence of 1–2 cases per million
annually. Its occurrence during pregnancy is exceptionally uncommon, presenting significant diagnostic and management challenges due to overlapping physiological changes
and concerns for both maternal and fetal outcomes. While
most cases are hormonally functional, non-functioning
ACC during pregnancy is particularly rare and may result
in delayed diagnosis.
Case:A 35-year-old Malay female was referred following ultrasonography for persistent back and left flank pain, which
revealed a left adrenal incidentaloma and a concurrent
10-week intrauterine pregnancy. There were no clinical
signs of hormone excess. Physical examination revealed a
normotensive patient with a large, palpable left abdominal
mass, without Cushingoid or virilizing features.
Magnetic resonance imaging (MRI) demonstrated a 12.1
× 10.3 × 12.8 cm heterogeneous left adrenal mass with
cystic and necrotic components, displacing adjacent
structures. Hormonal evaluation was within normal limits:
24-hour urinary cortisol 320.2 nmol/24 hours (reference
range [RR] 11.8–350), midnight salivary cortisol <3 and
4.2 nmol/L (RR <11.3), plasma metanephrine <0.2 nmol/L
(RR <0.5), normetanephrine 0.6 nmol/L (RR <0.9), and
17-hydroxyprogesterone 223 ng/dL (RR <285), consistent
with a non-functioning tumor.
Following multidisciplinary consultation, the patient
underwent open left adrenalectomy at 16 weeks’ gestation.
Histopathological analysis confirmed ACC (Weiss score
8/9) without extra-adrenal extension. Surveillance MRI at
32 weeks demonstrated no recurrence or residual mass.
At 40 weeks’ gestation, she delivered a healthy infant, and
both mother and child remain well on follow-up.
Conclusion:Non-functioning ACC during pregnancy is rare and
poses significant diagnostic challenges. Early imaging,
comprehensive hormonal assessment, and timely surgical
intervention during the second trimester are essential.
Multidisciplinary management is crucial to optimizing
maternal and fetal outcomes.
- Full text:2026072813114253379EP_A006.pdf
