Striae and an Adrenal Mass

A 27 year old pregnant woman presented with new-onset diabetes, hypertension, proximal muscle weakness, and violaceous striae. Laboratory tests revealed hypokalemia (2.9 mmol/L) and elevated 24 hour urinary free cortisol (3058 nmol). Imaging identified a 7cm right adrenal mass with features suggestive of malignancy (22 Hounsfield units). Post delivery, adrenalectomy confirmed high grade adrenocortical carcinoma without metastasis. The case highlights the diagnostic challenges of Cushing’s syndrome in pregnancy and the association with adrenal carcinoma. Management included antihypertensives, early delivery due to HELLP syndrome, and adjuvant mitotane therapy.

A 27 year old pregnant woman presented with new-onset diabetes, hypertension, proximal muscle weakness, and violaceous striae. Laboratory tests revealed hypokalemia (2.9 mmol/L) and elevated 24 hour urinary free cortisol (3058 nmol). Imaging identified a 7cm right adrenal mass with features suggestive of malignancy (22 Hounsfield units). Post delivery, adrenalectomy confirmed high grade adrenocortical carcinoma without metastasis. The case highlights the diagnostic challenges of Cushing’s syndrome in pregnancy and the association with adrenal carcinoma. Management included antihypertensives, early delivery due to HELLP syndrome, and adjuvant mitotane therapy.