Diagnostic rare : le corticosurrénalome

Adrencortical carcinoma is an aggressive form of cancer originating in the cortex of the adrenal gland with incidence of 1-2 per million inhabitants per year. Many hormonal syndromes can occur to patients with steroid hormones-producing tumors, including Cushing's syndrome, Conn syndrome, virilization and feminization. A 36-year-old female is admitted to emergency department for hypoglycemic coma without diabetic antecedents. Plasmatic glycemia is 2,36 mmol/L and kalemia 2,3 mmol/L. Radiography of the chest shows multiple small lung nodules (10-15 mm) indicating metastases to the lungs. Scans of the abdomen permits identifying the large (100 × 120 mm2) adrenocortical tumor on the right side. The patient is transferred to the Endocrinology Department. Hirsutism, change in the voice and high blood pressure, appeared during the last six months. This is the first hypoglycemic coma incident. Investigations are conducted with adrenocortical hormones, IGF family, “Big IGF2”, determinations, bone and cerebral CT scans. Adrenocortical carcinoma is evoked into the first 24 hours after hospitalization on the signs and symptoms of virilism, exces facial and body hair, acne, deepening of the voice, Conn syndrome marked by high blood pressure, hypokalemia and radiological pictures. Hypoglycemic coma due to secretion of “Big IGF2” is unusual as main first cause of hospitalisation in this case. This induced recurrent hypoglycemia combined to chemotherapy was a great difficulty for the treatment of the patient. It is necessary for patients with this rare disease to join multicentric trials in order to benefit of the most promising therapeutic options.