A case of childhood adrenocortical carcinoma

We describe a one year and seven months old baby girl who presented with a short history of pubic hair growth. The child was otherwise healthy and there were no other features of virilization. Her axillary hair and breast development were pre-pubertal (Tanner 1). Hormonal evaluation revealed markedly raised androgen levels.). There were no features of hypercortisolism or hyperaldosteronism. USS abdomen revealed a left sided adrenal mass measuring 6.8cm x 6cm. A left sided adrenalectomy was performed and the histology revealed features of an adrenocortical carcinoma with areas of necrosis, lymphatic and vascular invasion. Child was treated with adrenalectomy followed by mitotane therapy. This case highlights the importance of suspecting ACC in a young child presenting with pubarche in order to avoid delay in making the diagnosis.