Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2021; 9(20): 5575-5587
Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5575
Giant androgen-producing adrenocortical carcinoma with atrial flutter: A case report and review of the literature
Mircea-Florin Costache, Raluca-Elena Arhirii, Simona-Juliette Mogos, Corina Lupascu-Ursulescu, Cezara-Ioana Litcanu, Adi-Ionut Ciumanghel, Catalina Cucu, Cristina-Mihaela Ghiciuc, Antoniu-Octavian Petris, Nicolae Danila
Mircea-Florin Costache, Nicolae Danila, Surgery Clinic, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
Raluca-Elena Arhirii, Antoniu-Octavian Petris, Cardiology Clinic, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
Simona-Juliette Mogos, Department of Endocrinology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
Simona-Juliette Mogos, Endocrinology Clinic, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
Corina Lupascu-Ursulescu, Department of Radiology and Imaging Sciences, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
Corina Lupascu-Ursulescu, Radiology Clinic, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
Cezara-Ioana Litcanu, Radiotherapy Clinic, Regional Institute of Oncology, Iasi 700483, Romania
Adi-Ionut Ciumanghel, Anesthesia and Intensive Care Department, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
Adi-Ionut Ciumanghel, Anesthesia and Intensive Care Department, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
Catalina Cucu, Histopatology Department, Saint Spiridon University Clinical Emergency Hospital, Iasi 700111, Romania
Cristina-Mihaela Ghiciuc, Department of Pharmacology, Clinical Pharmacology and Algesiology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
Antoniu-Octavian Petris, Department of Cardiology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
Nicolae Danila, Surgery Clinic, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
Author contributions: Costache MF and Danila N were the patient’s surgeons, reviewed the literature, and contributed to manuscript drafting; Arhirii RE and Petris AO performed the cardiologic consultation, reviewed the literature, and drafted the manuscript; Mogos SJ performed the endocrinology consultation and contributed to manuscript drafting; Ciumanghel AI performed the anesthesia and intensive postoperative care; Cucu C performed the histopathological examination and interpretation and contributed to manuscript drafting; Lupascu-Ursulescu C and Litcanu CI analyzed and interpreted the imaging findings; Ghiciuc CM reviewed the literature and contributed to manuscript drafting; Costache MF, Arhirii RE, and Ghiciuc CM were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Raluca-Elena Arhirii, MD, Doctor, Cardiology Clinic, Saint Spiridon University Clinical Emergency Hospital, 1 Independentei Str, Iasi 700111, Romania. raluarhirii@yahoo.co.uk
Received: January 6, 2021
Peer-review started: January 6, 2021
First decision: February 12, 2021
Revised: March 24, 2021
Accepted: April 22, 2021
Article in press: April 22, 2021
Published online: July 16, 2021
Processing time: 182 Days and 7.8 Hours
Abstract
BACKGROUND

Adrenocortical carcinoma (ACC), the second most aggressive malignant tumor, lacks epidemiological data worldwide; therefore, every new case can improve the understanding of the pathology and treatment of this malignancy.

CASE SUMMARY

We present the case of a 66-year-old Caucasian woman with a giant androgen-producing ACC (21 cm × 17 cm × 12 cm; 2100 g), without metastases, which unusually presented with an acute onset of atrial flutter and congestive heart failure. The cardiac complications observed in our case support the hypothesis that androgen excess in women is a cardiovascular risk factor. Androgen excess in women can be a rare cause of reversible dilated cardiomyopathy, therefore a comprehensive approach to the patient is essential to improve the recognition of androgen-secreting ACC. The atrial flutter was remitted after initiation of drug treatment during admission. The severe heart failure was totally remitted at 6 mo after radical open surgery to remove the giant ACC.

CONCLUSION

Radical open surgery to remove a giant androgen-producing ACC was the first-line treatment to cure the excess of androgen, which determined the total remission of cardiac complications at 6 mo after surgery in the women of this case report.

Keywords: Adrenocortical carcinoma; Adrenalectomy; Androgen secreting tumor; Heart failure; Atrial flutter; Case report

Core Tip: We report one of the largest sized (21 cm × 17 cm × 12 cm; 2100 g), nonmetastasizing, androgen-producing but clinically paucisymptomatic adrenocortical carcinoma masses, which led to the admission of a 66-year-old Caucasian for cardiac complications (atrial flutter and severe heart failure) due to androgen excess. Androgen excess in women can be a rare cause of reversible dilated cardiomyopathy.