A case report of neonatal adrenocortical carcinoma

Abstract

Adrenocortical carcinoma is rarely seen in a neonatal period. Adrenocortical carcinoma usually causes virilisation, precocious puberty, Cushingoid syndrome. AimsDescribe a case of neonatal adrenocortical carcinoma diagnosed and treated in Vietnam National Hospital of Pediatrics. MethodA case report of neonatal adrenocortical carcinoma with Cushingoid syndrome and persistent hypertension. ResultsA boy was admitted to hospital at the age of 23 days because of vomiting, poor feeding and abdominal distension, and edema on both legs. On examination we found the child had Cushingoid syndrome, but not precocious puberty, edema on both legs, and hypertenstion. Blood pressure was 150/90 mmHg, required IV Loxen to maintain BP. Investigation showed cortisol 8AM was high of 4473 nmol/l; cortisol 24AM 3971 nmol/l. Electrolyte, renal function, glucose, urine VMA/HMA were normal. Abdominal ultrasound found a hypo-enhancing mass in the left adrenal area with calcification and dimension of 37x32 mm. Dilated left renal pelvis was also observed. Cardiac ultrasound found ventricular hypertrophy, suspected cardiomyopathy. Neck MRI detected abnormal connection between lymphatic vessels and venous vessels. Abdominal CT showed a heterogeneous mass of 40x41x50 mm with calcification in the left adrenal area. Operation was done to remove the mass. No metastase was noticed during operation. Histology confirmed a diagnosis of adrenocortical carcinoma. Cortical was normal after operation. However, hypertension was still present a week after operation and IV Loxen was indicated to maintain normal BP. ConclusionPost-operation hypertension was persistent in a neonatal adrenocortical carcinoma patient.