A Hormone-Producing Adrenocortical Tumor Detected on the Basis of Tumor Hemorrhage: A Case Report of a Female Infant

Abstract

Adrenocortical tumors (ACTs) in children often present endocrine symptoms such as virilization and are rarely detected on the basis of tumor hemorrhage. The patient was an eight-month-old female. She was taken to our hospital with chief complaints of vomiting and abdominal distension. Laboratory examination revealed severe anemia. Right adrenal hemorrhage or adrenal tumor with hemorrhage was suspected on the basis of ultrasound and computed tomography findings. The levels of tumor markers were not elevated. She revealed no signs of endocrine symptoms, but serum levels of dehydroepiandrostenedione sulphate (DHEA-S) and 17alphahydroxyprogesterone (17αOHP) were increased. After the hemorrhage was improved, magnetic resonance imaging revealed a right adrenal tumor. Thus, we diagnosed her as having right adrenocortical tumor and performed complete surgical resection. The tumor size was 55 × 40 mm, and the weight was 31 g. The patient was classified under the intermediate clinical outcome category on the basis of Wieneke criteria. During 5 months of follow up, she showed no signs of recurrence. Complete surgical resection without spillage is expected to result in a better prognosis of ACTs in children. In our patient, we performed complete resection without spillage. Nevertheless, the patient’s ACT was detected on the basis of tumor hemorrhage and we could not rule out the possibility of tumor spillage before the operation.