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Summary  Adrenal cortical carcinoma (ACC) has previously only been reported in eight patients with type 1 neurofibromatosis (NF1). There has not been any clear evidence of a causal association between  NF1  gene mutations and adrenocortical malignancy development. We report the case of a 49-year-old female, with no family history of endocrinopathy, who was diagnosed with ACC on the background of NF1, due to a novel germline frame shift mutation (c.5452_5453delAT) in exon 37 of the  NF1  gene. A left adrenal mass was detected by ultrasound and characterised by contrast computerised tomography (CT) scan. Biochemical tests showed mild hypercortisolism and androgen excess. A 24-h urinary steroid profile and  18 flouro deoxy glucose PET suggested ACC. An open adrenalectomy was performed and histology confirmed ACC. This is the first reported case with DNA analysis, which demonstrated the loss of heterozygosity (LOH) at the  NF1  locus in the adrenal cancer, supporting the hypothesis of an involvement of the  NF1  gene in the pathogenesis of ACC. LOH analysis of the tumour suggests that the loss of neurofibromin in the adrenal cells may lead to tumour formation.   Learning pointsACC is rare but should be considered in a patient with NF1 and adrenal mass when plasma metanephrines are normal.    Urinary steroid metabolites and PET/CT are helpful in supporting evidence for ACC.    The LOH at the  NF1  region of the adrenal tumour supports the role of loss of neurofibromin in the development of ACC.

Adrenal cancer in neurofibromatosis type 1: case report and DNA analysis