Adrenal gland disorders - adrenal carcinoma
Description
- Rare, aggressive malignancy of the adrenal cortex
- ~60% are hormonally functional at diagnosis
- Cortisol alone ~50-80% of functional tumours
- Cortisol + androgen mixed secretion is highly suggestive of ACC (an adenoma rarely does both)
- Androgen alone -> virilisation in women
- Oestrogen -> gynaecomastia in men (near-diagnostic of ACC)
- Aldosterone rarely
- Any adrenal mass >4 cm is ACC until proven otherwise
Size and imaging thresholds
| <4 cm, HU <=10, homogeneous | Almost certainly a benign adenoma |
| >4 cm | ~70% of ACCs; malignancy risk rises steeply |
| >6 cm | Resect |
| Unenhanced CT >10 HU + absolute washout <60% / relative <40% | Lipid-poor -> ACC, phaeo or metastasis |
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