{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T19:02:21Z","timestamp":1774551741079,"version":"3.50.1"},"reference-count":24,"publisher":"Bioscientifica","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"\n Summary<\/jats:title>\n This case report describes an 84-year-old male patient who presented with symptoms of intestinal obstruction and was subsequently diagnosed with metastatic adrenocortical carcinoma (ACC), a rare and aggressive endocrine malignancy. The patient arrived at the emergency department with abdominal pain, nausea, vomiting, and bloating. Imaging studies revealed a segmental ileal mass suggestive of obstruction and a large (12 \u00d7 8 cm) adrenal mass. Hormonal assays indicated a nonfunctional adrenal incidentaloma. Due to persistent obstruction, the patient underwent surgical resection of the terminal ileum and a left adrenalectomy. Histopathological examination confirmed ACC with metastasis to the small intestine. This rare presentation is notable because ACC typically manifests with hormone excess or mass effect symptoms, and intestinal metastasis causing mechanical obstruction is exceedingly uncommon. Radiologically, the adrenal mass lacked classic features of ACC, contributing to initial diagnostic uncertainty. Postoperatively, the patient recovered uneventfully and was started on mitotane therapy after PET imaging confirmed residual disease and para-aortic lymph node metastasis. This report underscores the importance of thorough evaluation of large adrenal incidentalomas, even if nonfunctional, and highlights intestinal obstruction as a rare but possible initial presentation of metastatic ACC. It contributes to the limited literature documenting atypical clinical manifestations of this rare tumor.<\/jats:p>\n <\/jats:sec>\n \n Learning points<\/jats:title>\n \n \n Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy that is frequently diagnosed at an advanced or metastatic stage.<\/jats:p>\n <\/jats:list-item>\n \n Nonfunctional adrenal incidentalomas \u22654 cm in size warrant comprehensive hormonal evaluation and imaging, followed by multidisciplinary assessment due to the potential risk of malignancy.<\/jats:p>\n <\/jats:list-item>\n \n In this case, despite benign-appearing radiological features, histopathological examination confirmed that the adrenal mass was a metastatic adrenocortical carcinoma.<\/jats:p>\n <\/jats:list-item>\n \n R0 resection remains the only potentially curative treatment for ACC; in selected cases, synchronous resection of metastatic lesions may be necessary.<\/jats:p>\n <\/jats:list-item>\n \n This case highlights a previously undocumented presentation of ACC manifesting as small bowel obstruction due to intestinal metastasis, thereby expanding the clinical spectrum of this rare entity.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-25-0083","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T13:00:49Z","timestamp":1769778049000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["A nonfunctional adrenal incidentaloma revealed by intestinal obstruction: metastatic adrenocortical carcinoma diagnosed by surgery"],"prefix":"10.1530","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2618-3349","authenticated-orcid":true,"given":"Yasemin","family":"Keskin","sequence":"first","affiliation":[{"name":"Department of General Surgery, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0832-2334","authenticated-orcid":true,"given":"P\u0131nar","family":"Da\u011f","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2714-1436","authenticated-orcid":true,"given":"Elif Buse","family":"G\u00fcng\u00f6r","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Ann Surg Oncol","first-page":"1965","article-title":"Adrenocortical carcinoma: the value of lymphadenectomy","volume":"29","author":"Tseng J","year":"2022","unstructured":"Tseng J\n, \nDiPeri T\n, \nChen Y\n, et al.\n Adrenocortical carcinoma: the value of lymphadenectomy. Ann Surg Oncol 2022 29 1965\u20131970. (https:\/\/doi.org\/10.1245\/s10434-021-11051-5)"},{"key":"bib2","series-title":"J Palliat Med","first-page":"508","article-title":"Eastern Cooperative Oncology Group Performance Status #434","volume":"25","author":"Mischel AM","year":"2022","unstructured":"Mischel AM\n & \nRosielle DA\n\n. Eastern Cooperative Oncology Group Performance Status #434. J Palliat Med 2022 25 508\u2013510. (https:\/\/doi.org\/10.1089\/jpm.2021.0599)"},{"key":"bib3","series-title":"StatPearls [Internet]","article-title":"Ileus. [Updated 2023 Aug 23]","author":"Beach EC","year":"2025","unstructured":"Beach EC\n & \nDe Jesus O\n\n. Ileus. [Updated 2023 Aug 23]. In: \nStatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK558937\/."},{"key":"bib4","series-title":"Endocr Pract","first-page":"1366","article-title":"American Association of Clinical Endocrinology Disease State Clinical review on the evaluation and management of adrenocortical carcinoma in an adult: a practical approach","volume":"26","author":"Kiseljak-Vassiliades K","year":"2020","unstructured":"Kiseljak-Vassiliades K\n, \nBancos I\n, \nHamrahian A\n, et al.\n American Association of Clinical Endocrinology Disease State Clinical review on the evaluation and management of adrenocortical carcinoma in an adult: a practical approach. Endocr Pract 2020 26 1366\u20131383. 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(https:\/\/doi.org\/10.1530\/EJE-18-0608)"},{"key":"bib6","series-title":"Cancer Treat Res Commun","article-title":"Adrenocortical carcinoma: diagnosis, prognostic classification and treatment of localized and advanced disease","volume":"37","author":"Lib\u00e9 R","year":"2023","unstructured":"Lib\u00e9 R\n & \nHuillard O\n\n. Adrenocortical carcinoma: diagnosis, prognostic classification and treatment of localized and advanced disease. Cancer Treat Res Commun 2023 37 100759. (https:\/\/doi.org\/10.1016\/j.ctarc.2023.100759)"},{"key":"bib7","series-title":"Endocr Pract","first-page":"178","article-title":"The evaluation of incidentally discovered adrenal masses","volume":"25","author":"Vaidya A","year":"2019","unstructured":"Vaidya A\n, \nHamrahian A\n, \nBancos I\n, et al.\n The evaluation of incidentally discovered adrenal masses. Endocr Pract 2019 25 178\u2013192. 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Surg Pathol Clin 2019 12 997\u20131006. (https:\/\/doi.org\/10.1016\/j.path.2019.08.010)"},{"key":"bib11","series-title":"Endocr Rev","first-page":"282","article-title":"Adrenocortical carcinoma","volume":"35","author":"Else T","year":"2014","unstructured":"Else T\n, \nKim AC\n, \nSabolch A\n, et al.\n Adrenocortical carcinoma. Endocr Rev 2014 35 282\u2013326. (https:\/\/doi.org\/10.1210\/er.2013-1029)"},{"key":"bib12","series-title":"Anticancer Res","first-page":"5575","article-title":"Prevalence and prognostic value of lymph node dissection in treating adrenocortical carcinoma: a national experience","volume":"35","author":"Alanee S","year":"2015","unstructured":"Alanee S\n, \nDynda D\n & \nHolland B\n\n. Prevalence and prognostic value of lymph node dissection in treating adrenocortical carcinoma: a national experience. 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