Metastatic Adrenal Cortical Carcinoma in an Otherwise Asymptomatic 32 y/o Patient Presenting with Back Pain

INTRODUCTION: This is a case of a metastatic adrenal cortical carcinoma in an otherwise healthy patient. CASE DESCRIPTION: AT is a 32 year old male with no PMH who presented to the hospital for right lower back pain with radiation to the R buttock, right groin and RLE worse with ambulation. The patient stated that the pain has been ongoing for the past 2 months, getting progressively worse. Pt endorsed mild night sweats. He was sent for a CT scan of the lumbar spine. Incidentally, a left adrenal mass was identified. Subsequently , a CT of the abdomen was performed which redemonstrated the adrenal mass, and he was found to have a liver mass, as well as a soft tissue mass causing lytic erosion of the right hip. Biopsy of the left adrenal mass revealed a poorly differentiated carcinoma. Bone scan was then performed which demonstrated multiple skeletal metastases including lesions in the calvarium. CA19-9, CEA were negative. Metanephrines, cortisol were within normal limits. Patient was informed about his results and was recommended for systemic chemotherapy prior to considering surgical or radiation therapy. DISCUSSION: Primary adrenal cortical carcinoma is a highly malignant but rare neoplasm. It may present as a hormonally active or an inactive tumor. Mean age of presentation is age 50. Can be associated with syndromes such as Beckwith-Wiedemann syndrome, Li-Fraumeni syndrome, Carney complex, multiple endocrine neoplasia type 1, familial adenomatous polyposis. Diagnosis of metastatic adrenal cortical carcinoma can be a devastating however it is prudent for clinicians to be aware of its presentation.