Adrenocortical carcinoma presenting with extensive striae: A case report and literature review

Adrenocortical tumors are rare tumors in childhood. Virilization is the most common symptom, but about 5.5% of patients may also present with isolated Cushing's syndrome. A girl 15 years and 8 months of age presented with complaints of striae on her legs, acne for 2 weeks, and amenorrhea for 2 months. On physical examination, extensive striae were observed on her legs and abdomen. On hormonal investigation, her adrenocorticotropic hormone level was <5 pg/ml, cortisol was 35.4 & micro;g/dl. Her hypercortisolism raised suspicion of Cushing's syndrome. Adrenal MRI revealed a right adrenal mass approximately 9 cm in diameter. Pleural metastasis was detected and the patient was diagnosed as having stage 4 adrenocortical carcinoma. Despite treatment, she died 9 months after diagnosis. Our case followed an aggressive clinical course and was unique due to the presence of extensive striae without pronounced virilization or Cushingoid symptoms.