An aggressive multimodal treatment, including repeated surgical approach with consolidating radiotherapy in cases of incomplete resection, might be indicated to provide symptom control and possible long-term survival in oligometastatic disease of ACC. In this case of oligometastasizing ACC, serum cortisol values correlated with the clinical course. Conclusion: Careful clinical and radiographic follow-up of patients with ACC are important. Following curettage and stabilization, radiotherapy of this region with 37.5 Gy was performed, improving slightly elevated cortisol levels and neurological symptoms. One year later, the patient was diagnosed with a solitary osseous metastasis at the left side of the sacrum because of back pain. Treatment with mitotane (o, p'-DDD) as a cytostatic agent was not tolerated. Postoperatively, cortisol declined to normal levels. Initial histological diagnosis was revised according to the increased proliferative changes. Diagnostic work-up revealed hepatic metastatic lesions of an ACC which were treated by right hemihepatectomy. Hypercortisolism occurred again two years later. Postoperatively, elevated serum cortisol levels normalized. An adrenocortical carcinoma (ACC) is a cancerous adrenal tumor that forms in the adrenal cortex. Histological examination after a left adrenalectomy revealed a benign tumour. Case Report: A 55-year-old Caucasian woman presented with adrenal Cushing's disease. Treatment guidelines have not been established, but are currently under investigation. Background: Adrenocortical carcinoma (ACC) is a rare tumour, sometimes causing glucocorticoid hypersecretion.
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