Adrenocortical carcinoma physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2] Ahmad Al Maradni, M.D. [3] Mohammed Abdelwahed M.D[4]
Overview
Common physical examination findings of adrenocortical carcinoma include Cushing's syndrome findings such as hypertension, weakness, gynecomastia, and acne. Hyperandrogenic cases may show findings such as clitoromegaly and hirsutism.
Physical Examination
Appearance of the patient
- 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 type2 diabetes mellitus and Cushing's syndrome.[3]
Vitals
- 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
Chest
Skin
- 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 hemorrhage) on the trunk, buttocks, arms, legs or breasts, and proximal muscle weakness
- Hirsutism
Head
- Facial flushing[5]
- Scleral icterus in case of metastasis to the liver
- Moon-face is a medical sign where the face swells up into a rounded shape. It is often associated with Cushing's syndrome, which has led to it being known as Cushingoid facies, or steroid treatment[4]
- Alopecia
Abdomen
- A palpable abdominal mass in the lower abdominal quadrant[5]
- Guarding may be present.
- Hepatomegaly if malignant secondaries found in liver
- Diarrhea caused by gastrointestinal secretion of fluid and electrolytes, and flushing in medullary thyroid cancer patients
Extremities
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities[6]
- Muscle atrophy
- Fasciculations in the upper/lower extremity
Neurologic
Genitals
References
- ↑ Nieman LK (2015). "Cushing's syndrome: update on signs, symptoms and biochemical screening". Eur J Endocrinol. 173 (4): M33–8. doi:10.1530/EJE-15-0464. PMC 4553096. PMID 26156970.
- ↑ La Batide-Alanore A, Chatellier G, Plouin PF (2003). "Diabetes as a marker of pheochromocytoma in hypertensive patients". J Hypertens. 21 (9): 1703–7. doi:10.1097/01.hjh.0000084729.53355.ce. PMID 12923403.
- ↑ Drénou B, Le Tulzo Y, Caulet-Maugendre S, Le Guerrier A, Leclercq C, Guilhem I; et al. (1995). "Pheochromocytoma and secondary erythrocytosis: role of tumour erythropoietin secretion". Nouv Rev Fr Hematol. 37 (3): 197–9. PMID 7567437.
- ↑ 4.0 4.1 Nieman LK (2015). "Cushing's syndrome: update on signs, symptoms and biochemical screening". Eur J Endocrinol. 173 (4): M33–8. doi:10.1530/EJE-15-0464. PMC 4553096. PMID 26156970.
- ↑ 5.0 5.1 Simonenko VB, Makanin MA, Dulin PA, Vasilchenko MI, Lesovik VS (2012). "[About the signs of malignant pheochromocytoma]". Klin Med (Mosk). 90 (10): 64–8. PMID 23285767.
- ↑ Brunaud L, Duh QY (2002). "Aldosteronoma". Curr Treat Options Oncol. 3 (4): 327–33. PMID 12074769.