Adrenocortical Carcinoma
Adrenocortical carcinoma (ACC) is rare but aggressive, and the practical challenge is the adrenal mass — most are benign incidentalomas, and the job is to flag the few that are malignant (or functional) and need removal.
The big picture
Adrenocortical carcinoma (ACC) is rare but aggressive, and the practical challenge is the adrenal mass — most are benign incidentalomas, and the job is to flag the few that are malignant (or functional) and need removal. Two features drive that decision: size and imaging characteristics, backed by a hormonal workup. Get the malignancy/function triage right and you operate on the right masses.
The framework: an adrenal mass → assess malignant potential (size + imaging) and function (hormones) → adrenalectomy for the suspicious or functional, surveillance for the clearly benign → ACC needs aggressive resection.
Mechanism pathway
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Diagnostic algorithm
Each step answers one question. Tap to expand.
Board traps
Adrenal mass >4 cm or with suspicious imaging → think malignancy → resect.
ACC usually presents large (often >6 cm) and is often functional (cortisol/androgens).
Always exclude pheochromocytoma before any adrenal biopsy or surgery (crisis risk).
Avoid biopsy of adrenal masses (non-diagnostic, dangerous in pheochromocytoma, seeding in ACC).
Complete resection is the only cure for ACC; open adrenalectomy preferred (avoid spillage); mitotane adjuvant/advanced.
Benign non-functional small masses → surveillance.