{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T21:26:40Z","timestamp":1786829200588,"version":"build-2736575974"},"reference-count":18,"publisher":"Journal of the ASEAN Federation of Endocrine Societies (JAFES)","issue":"2","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J ASEAN Fed Endocr Soc"],"abstract":"<jats:p>Adrenocortical carcinoma (ACC) is a rare malignancy, accounting for 0.05-2% of all malignant tumors. Most cases are sporadic and asymptomatic, often discovered incidentally via imaging. However, 50-60% present with autonomous hormonal secretion, with 45% producing excess cortisol, and only 1% exhibiting mineralocorticoid excess.\nWe report a 43-year-old Filipino woman with a 6-month history of abdominal bloating, proximal muscle weakness, edema, and hypertension. Laboratory tests showed hypokalemia (serum potassium 2.5-3.05 mmol\/L; normal 3.3-5.0 mmol\/L). Imaging revealed an incidental right adrenal mass measuring 4.7 x 3.6 x 6.1 cm, with Hounsfield units of 40, along with periportal and paraaortic lymphadenopathies.\nBiochemical evaluation indicated primary hyperaldosteronism: suppressed plasma renin (0.97 ng\/ml\/hr; normal 0.39-3.94 ng\/ml\/hr), normal plasma aldosterone (21.61 ng\/dl; normal 4-31ng\/dl), and an elevated aldosterone-renin ratio of 22.27. Confirmatory testing was not done due to undetectable plasma renin, plasma aldosterone &gt;20 ng\/dl, and ongoing hypokalemia. Additionally, she had non-suppressed cortisol (31.88 mcg\/dl; normal &lt;1.8mcg\/dl) on a low-dose dexamethasone test, and low ACTH (2.81 pg\/ml; normal 7.7-63.6pg\/ml), indicating ACTH-independent Cushing's syndrome. Tests ruled out catecholamine and androgen excess with normal urine metanephrines and serum DHEAS, respectively.\nSurgical removal via open adrenalectomy was performed. Histopathology confirmed ACC, supported by immunohistochemistry. Postoperative treatment included radiotherapy and planned adjuvant mitotane therapy. During follow-up, the patient\u2019s blood glucose and pressure worsened, requiring medication adjustments. Unfortunately, the patient succumbed to the disease seven months post-surgery.\nThis case highlights the importance of thorough evaluation when diagnosing complex cases involving simultaneous cortisol and aldosterone secretion in adrenal tumors, highlighting the challenges and the need for prompt management of this rare coexistence.<\/jats:p>","DOI":"10.15605\/jafes.041.02.5875","type":"journal-article","created":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T21:18:37Z","timestamp":1786828717000},"source":"Crossref","is-referenced-by-count":0,"title":["Adrenocortical Carcinoma with Suspected Dual Cortisol and Aldosterone Secretion"],"prefix":"10.15605","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3882-6442","authenticated-orcid":false,"given":"Ciara Fatima","family":"Jaime","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5256-8018","authenticated-orcid":false,"given":"Florence Rochelle","family":"Gan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6244","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"86442","doi-asserted-by":"crossref","unstructured":"1. Fassnacht M, Dekkers OM, Else T, et al. European Society of Endocrinology clinical practice guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2018;179(4):G1-46. https:\/\/pubmed.ncbi.nlm.nih.gov\/30299884 https:\/\/doi.org\/10.1530\/EJE-18-0608","DOI":"10.1530\/EJE-18-0608"},{"key":"86443","doi-asserted-by":"crossref","unstructured":"2. Adler GK, Stowasser M, Correa RR, et al. Primary aldosteronism: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2025;110(9):2453-95. https:\/\/pubmed.ncbi.nlm.nih.gov\/40658480 https:\/\/doi.org\/10.1210\/clinem\/dgaf284","DOI":"10.1210\/clinem\/dgaf284"},{"key":"86444","doi-asserted-by":"crossref","unstructured":"3. Nieman LK, Biller BM, Findling JW, et al. The diagnosis of Cushing\u2019s syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(5):1526-40. https:\/\/pubmed.ncbi.nlm.nih.gov\/18334580 https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2386281 https:\/\/doi.org\/10.1210\/jc.2008-0125","DOI":"10.1210\/jc.2008-0125"},{"key":"86445","doi-asserted-by":"crossref","unstructured":"4. Abeynayake DR, Sopan V, Perera KJC, Paramanantham A, Munasinghe TMJ. Adrenal carcinoma: A case report. J Med Case Rep. 2022;16(1):229. https:\/\/pubmed.ncbi.nlm.nih.gov\/35637536 https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC9153213 https:\/\/doi.org\/10.1186\/s13256-022-03398-4","DOI":"10.1186\/s13256-022-03398-4"},{"key":"86446","doi-asserted-by":"crossref","unstructured":"5. Lazaro K, Adorable-Wagan P. Aldosterone-producing adrenocortical carcinoma with co-secretion of cortisol and estradiol: A case report. J ASEAN Fed Endocr Soc. 2018;33(1):57-62. https:\/\/pubmed.ncbi.nlm.nih.gov\/33442112 https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7784201 https:\/\/doi.org\/10.15605\/jafes.033.01.10","DOI":"10.15605\/jafes.033.01.10"},{"key":"86447","doi-asserted-by":"crossref","unstructured":"6. Eisa N. Adrenocortical carcinoma presenting with concurrent Cushing syndrome and primary hyperaldosteronism. AACE Endocrinology and Diabetes. 2026. https:\/\/doi.org\/10.1016\/j.aed.2026.02.003","DOI":"10.1016\/j.aed.2026.02.003"},{"key":"86448","doi-asserted-by":"crossref","unstructured":"7. Berruti A, Fassnacht M, Haak H, et al. Prognostic role of overt hypercortisolism in completely operated patients with adrenocortical cancer. European Urology, 2014;65(4), 832\u20138. https:\/\/pubmed.ncbi.nlm.nih.gov\/24268504 https:\/\/doi.org\/10.1016\/j.eururo.2013.11.006","DOI":"10.1016\/j.eururo.2013.11.006"},{"key":"86449","doi-asserted-by":"crossref","unstructured":"8. Ali\u00f1o MM, Tam-Go LM. Diagnosis and management of adrenocortical carcinoma with co-secretion of cortisol and aldosterone: a case report. J ASEAN Fed Endocr Soc. 2024;39(2):103-7. https:\/\/pubmed.ncbi.nlm.nih.gov\/39620173 https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC11604353 https:\/\/doi.org\/10.15605\/jafes.039.02.13","DOI":"10.15605\/jafes.039.02.13"},{"key":"86450","doi-asserted-by":"crossref","unstructured":"9. Kurtulmu\u015f N, Yarman S, Azizlerli H, Kapran Y. Co-secretion of aldosterone and cortisol by an adrenocortical carcinoma. Hormone Research. 2004;62(2), 67\u201370. https:\/\/pubmed.ncbi.nlm.nih.gov\/15218335 https:\/\/doi.org\/10.1159\/000079322","DOI":"10.1159\/000079322"},{"key":"86451","doi-asserted-by":"crossref","unstructured":"10. Prete A, Bancos I. Mild autonomous cortisol secretion: pathophysiology, comorbidities and management approaches. Nat Rev Endocrinol. 2024;20(8):460-73. https:\/\/pubmed.ncbi.nlm.nih.gov\/38649778 https:\/\/doi.org\/10.1038\/s41574-024-00984-y","DOI":"10.1038\/s41574-024-00984-y"},{"key":"86452","doi-asserted-by":"crossref","unstructured":"11. Moreno S, Montoya G, Armstrong J, et al. Profile and outcome of pure androgen-secreting adrenal tumors in women: Experience of 21 cases. Surgery. 2004;136(6):1192-8. https:\/\/pubmed.ncbi.nlm.nih.gov\/15657575 https:\/\/doi.org\/10.1016\/j.surg.2004.06.046","DOI":"10.1016\/j.surg.2004.06.046"},{"key":"86453","unstructured":"12. Villa[1.1] M, Quimpo J. Endocrine protocols: A handbook on the use and interpretation of tests, 2nd ed; 2020."},{"key":"86454","doi-asserted-by":"crossref","unstructured":"13. Papotti M, Lib\u00e8 R, Duregon E, Volante M, Bertherat J, Tissier F. The Weiss score and beyond--histopathology for adrenocortical carcinoma. Horm Cancer. 2011;2(6):333-40. https:\/\/pubmed.ncbi.nlm.nih.gov\/21997290 https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC10358021 https:\/\/doi.org\/10.1007\/s12672-011-0088-0","DOI":"10.1007\/s12672-011-0088-0"},{"key":"86455","doi-asserted-by":"crossref","unstructured":"14. Weiss LM, Medeiros LJ, Vickery AL Jr. Pathologic features of prognostic significance in adrenocortical carcinoma. Am J Surg Pathol. 1989;13(3):202-6. https:\/\/pubmed.ncbi.nlm.nih.gov\/2919718 https:\/\/doi.org\/10.1097\/00000478-198903000-00004","DOI":"10.1097\/00000478-198903000-00004"},{"key":"86456","doi-asserted-by":"crossref","unstructured":"15. Jorda M, De MB, Nadji M. Calretinin and inhibin are useful in separating adrenocortical neoplasms from pheochromocytomas. Appl Immunohistochem Mol Morphol. 2002;10(1):67-70. https:\/\/pubmed.ncbi.nlm.nih.gov\/11893039 https:\/\/doi.org\/10.1097\/00129039-200203000-00012","DOI":"10.1097\/00129039-200203000-00012"},{"key":"86457","doi-asserted-by":"crossref","unstructured":"16. Lib\u00e9 R, Huillard O. Adrenocortical carcinoma: Diagnosis, prognostic classification and treatment of localized and advanced disease. Cancer Treat Res Commun. 2023;37:100759. https:\/\/pubmed.ncbi.nlm.nih.gov\/37690343 https:\/\/doi.org\/10.1016\/j.ctarc.2023.100759","DOI":"10.1016\/j.ctarc.2023.100759"},{"key":"86458","doi-asserted-by":"crossref","unstructured":"17. Lib\u00e9 R, Borget I, Ronchi CL, et al. Prognostic factors in stage III-IV adrenocortical carcinomas (ACC): An European Network for the Study of Adrenal Tumor (ENSAT) study. Ann Oncol. 2015;26(10):2119-25. https:\/\/pubmed.ncbi.nlm.nih.gov\/26392430 https:\/\/doi.org\/10.1093\/annonc\/mdv329","DOI":"10.1093\/annonc\/mdv329"},{"key":"86459","doi-asserted-by":"crossref","unstructured":"18. Elhassan Y, Altieri B, Berhane S, et al. Modified GRAS score for prognostic classification of adrenocortical carcinoma: An ENSAT multicentre study. Endocrine Abstracts. 2020; 70 OC1.6. https:\/\/doi.org\/10.1530\/endoabs.70.OC1.6","DOI":"10.1530\/endoabs.70.OC1.6"}],"container-title":["Journal of the ASEAN Federation of Endocrine Societies"],"original-title":[],"link":[{"URL":"https:\/\/asean-endocrinejournal.org\/index.php\/JAFES\/article\/download\/5875\/5343","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/asean-endocrinejournal.org\/index.php\/JAFES\/article\/download\/5875\/5343","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T21:18:40Z","timestamp":1786828720000},"score":1,"resource":{"primary":{"URL":"https:\/\/asean-endocrinejournal.org\/index.php\/JAFES\/article\/view\/5875"}},"subtitle":["A Case Report"],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":18,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,8,6]]}},"URL":"https:\/\/doi.org\/10.15605\/jafes.041.02.5875","relation":{},"ISSN":["2308-118X","0857-1074"],"issn-type":[{"value":"2308-118X","type":"electronic"},{"value":"0857-1074","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8,7]]}}}