Adrenocortical carcinoma (ACC) is a malignant tumour arising from the adrenal cortex, while
pheochromocytoma is a
catecholamine secreting tumour of the adrenal medulla or extra adrenal sites. Both conditions are very rare, with incidence of approximately 1-2 cases per million adults annually. Most adrenocortical tumours are functioning. ACC can be associated with clinical
Cushing syndrome and virilisation due to excessive production of
cortisol and
androgens, respectively. However, it is rare for ACC to present clinically as
pheochromocytoma. We report a case of a 28-year-old lady who presented with paroxysmal
hypertension and palpitations associated with raised urinary vanillyl
mandelic acid. On examination, there was
postural hypotension and ballotable mass in right lumbar region with no obvious features suggestive of
Cushing syndrome or virilisation. A huge right suprarenal mass with areas of
necrosis and calcification was noted on the abdomen CT. A right
adrenalectomy was done. The histology was consistent with ACC. There are reported cases of ACC presenting with clinical features of
pheochromocytoma but limited in number, accounting for barely a dozen cases in the literature. This pseudopheochromocytoma may be due to the presence of neuroendocrine features in ACC.