Striae and an Adrenal Mass

This case report describes a 27 year old primigravid woman presenting with new-onset diabetes, hypertension, and clinical signs of Cushing’s syndrome (proximal muscle weakness, violaceous striae, and facial plethora). Laboratory findings included hypokalemia and elevated 24 hour urinary free cortisol (3058 nmol). Imaging revealed a 7 cm right adrenal mass, later confirmed as high-grade adrenocortical carcinoma after adrenalectomy. The patient developed HELLP syndrome at 34 weeks of gestation, necessitating delivery. Postpartum management included adjuvant mitotane therapy. The report highlights the diagnostic challenges and multidisciplinary approach required for adrenal carcinoma in pregnancy.

This case report describes a 27 year old primigravid woman presenting with new-onset diabetes, hypertension, and clinical signs of Cushing’s syndrome (proximal muscle weakness, violaceous striae, and facial plethora). Laboratory findings included hypokalemia and elevated 24 hour urinary free cortisol (3058 nmol). Imaging revealed a 7 cm right adrenal mass, later confirmed as high-grade adrenocortical carcinoma after adrenalectomy. The patient developed HELLP syndrome at 34 weeks of gestation, necessitating delivery. Postpartum management included adjuvant mitotane therapy. The report highlights the diagnostic challenges and multidisciplinary approach required for adrenal carcinoma in pregnancy.