Fariba Karimi
1* 
, Amirreza Dehghanian
2, Mohammadjavad Fallahi
3, Behnam Dalfardi
31 Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2 Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
3 Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy. Most patients present with steroid hormone excess or abdominal mass effect. Pure androgen-secreting ACCs are rare, while hypoglycemia is an unusual presentation of this malignancy. We present a 26-year-old woman with hypoglycemia and history of adrenalectomy due to a large adrenal mass which was diagnosed as nonfunctional adrenal adenoma. She was admitted in our hospital 10 days after her fetal loss with repeated episodes of severe hypoglycemia. She had a high serum dehydroepiandrosterone sulfate (DHEA-S) and her hypoglycemia was associated with low insulin and C-peptide levels. Imaging revealed liver metastasis and immunohistochemical studies of the biopsied lesions confirmed the diagnosis of ACC.