Adrenocortical carcinoma physical examination

Common physical examination findings of adrenocortical carcinoma include findings of Cushing’s syndrome such as hypertension, weakness, gynecomastia, and acne. Hyperandrogenic cases may show findings such as clitoromegaly and hirsutism. 

• Moon-like face^[1]
• Buffalo hump
• Patients may appear flushed due to the associated increase in erythropoietin secretion.^[2]
• Patients may appear obese due to associated type 2 diabetes mellitus and Cushing’s syndrome.^[3]

• Hypotension occurs due to fluid contraction
• Hypertension due to cortisol’s enhancement of epinephrine‘s vasoconstrictive effect
• Tachypnea if malignant secondaries are found in the lung
• Dyspnea occurs in patients with complicated heart failure and cardiomyopathy

• Gynecomastia

• The skin may be fragile and thin ^[4]
• Jaundice secondary to deranged liver function in case of metastasis to the liver
• Hyperpigmentation – this is due to melanocyte-stimulating hormone production as a byproduct of ACTH synthesis from Proopiomelanocortin (POMC)
• Telangiectasia (dilation of capillaries)
• Thinning of the skin (which causes easy bruising)
• Purple or red striae (the weight gain in Cushing’s stretches the skin, which is thin and weakened, causing it to bleed) on the trunk, buttocks, arms, legs or breasts, and proximal muscle weakness
• Hirsutism
• Dehydration caused by gastrointestinal secretion of fluid and electrolytes

• Facial flushing ^[5]
• Scleral icterus in case of metastasis to the liver
• Moon-face  is often associated with Cushing’s syndrome, also known as Cushingoid facies ^[4]
• Alopecia

• A palpable abdominal mass in the lower abdominal quadrant ^[5]
• Guarding may be present
• Hepatomegaly if malignant secondaries found in liver
• flushing in medullary thyroid cancer patients

• Clubbing
• Cyanosis
• Pitting/non-pitting edema of the upper/lower extremities ^[6]
• Muscle atrophy
• Fasciculations in the upper/lower extremity

• Confusion

• Clitoromegaly

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