We present the case of a 67-year-old woman who came to the emergency department for bilateral conjunctival oedema of 3 weeks' evolution, after having been treated with artificial tears and topical antibiotic-corticoid ointment during this period of time without improvement. The patient's personal history included arterial hypertension under pharmacological treatment, diabetes mellitus that was difficult to control and recently diagnosed oral candidiasis.
Ophthalmological examination revealed bilateral conjunctival chemosis with intense tearing, and the rest of the ophthalmological examination was normal. The patient reported having lost 5 kg in the last 2 weeks, a feeling of generalised swelling, especially in the face, together with asthenia and generalised pruritus.

After a systemic examination she was diagnosed with suspected Cushing's syndrome. Hormonal tests revealed an ACTH of 3 pg/mL (normal 10-55), basal plasma cortisol of 35.3 mcg/dL and urinary free cortisol (UFC) of 632 mcg/24h (normal < 180). Chest X-ray and computed tomography (CT) were normal. Abdominal CT scan showed a left adrenal mass measuring 8.2×5.4cm, suggestive of adrenal carcinoma, with no locoregional adenopathies.

Given the clinical evolution, it was decided to start treatment with ketoconazole 400mg/day prior to surgery in order to inhibit adrenal cortisol secretion, and the adrenal tumour was excised together with dissection of the surrounding fat, with complete resolution of the chemosis.

The histology of the adrenal tumour was reported as "adrenocortical carcinoma with extensive zone of necrosis with proliferative activity, infiltrating the surrounding capsule and invading the pericapsular lymphatic vessels". After an initial course of chemotherapy with cisplatin-etoposide, he was diagnosed 3 months later with multiple bilateral pulmonary metastases in both hemithoraxes and a local recurrence at the left adrenal level by means of a thoraco-abdomino-pelvic CT scan, for which he received three cycles of chemotherapy with cyclophosphamide, adriamycin and vincristine, without improvement, with progression of respiratory and cardiac insufficiency, starting treatment with weekly taxol for 2 months (antineoplastic chemotherapy), dying due to the progressive respiratory insufficiency he presented.