Adrenocortical oncocytic neoplasm of uncertain malignant potential in pregnancy

CLINICAL VIGNETTEand her body mass index was 23.3 kg/m 2 .There were no clinical signs of hypertension, hypokalemia, Cushingoid features, or virilization.Biochemical evaluation excluded hypercortisolism and pheochromocytoma.Androgen levels were elevated, consistent with physiological pregnancy-related changes.The lesion was therefore classified as non-functioning.Detailed hormonal results are presented in Table 1.Because of the ongoing pregnancy, no further adrenal imaging was performed.Fetal ultrasound showed normal cardiac activity and amniotic fluid volume, with a relatively small head circumference for gestational age.First-trimester screening had indicated high-risk results.A 33-year-old woman (gravida 5, para 4) was referred at 18 weeks of gestation after detection of a 9 cm right adrenal mass.Two months earlier, at an outside institution, she had presented with persistent upper abdominal pain, nausea, and vomiting.Upper gastrointestinal endoscopy revealed Helicobacter pylori-positive pangastritis, for which she received quadruple eradication therapy including tetracycline.Abdominal ultrasonography demonstrated a solid lesion adjacent to the upper pole of the right kidney.Subsequent contrast-enhanced abdominal computed tomography (CT) revealed a 90 × 79 mm heterogeneous right adrenal mass with internal calcifications and necrotic components, and pregnancy was incidentally identified during this imaging, at which time the gestational age was 9 weeks (Fig. 1).At admission to our center, the patient had no significant comorbidities and no clinical features of adrenal hormone excess.On physical examination, her vital signs were normal, systemic examination was unremarkable,