April 5th, 2020

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Adrenal Mass Diagnosed in the Third Trimester of Pregnancy: A Case Report
Authors:  Amanda Sparks, M.D., Stephen J. Carlan, M.D., Jack Wilson, M.D., and John Busowski, M.D.
BACKGROUND: Primary adrenocortical carcinoma (ACC) is an extremely rare condition in pregnancy, with fewer than 30 cases reported to date. Most cases complicating pregnancy are diagnosed after excess adrenal hormone production is discovered. The prognosis is poor, and treatment includes surgical excision of the tumor.

CASE: A 19-year-old woman at 36 weeks’ gestation presented with sudden onset of severe right flank pain and no clinical evidence of excess adrenal hormone production. Magnetic resonance imaging and ultrasound confirmed a 13-cm right solid adrenal mass. After ultrasound revealed a sudden increase in the tumor’s size, an open kidney-sparing adrenalectomy was performed on postcesarean day 4. The initial diagnosis of stage IIIA malignant pheochromocytoma was subsequently changed to ACC.

CONCLUSION: ACC should be considered in pregnancy when a painful adrenal mass is noted on imaging. Ultrasound is a reliable, inexpensive, and gentle method of serially imaging an adrenal gland mass in pregnancy and the puerperium.
Keywords:  adrenal gland diseases, adrenal mass, adrenalectomy, adrenocortical carcinoma, diagnostic ultrasound, pain, pregnancy, pregnancy complications, ultrasonography
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