Introduction: Adrenocortical carcinoma is a rare and severe malignant tumor that in 60% of cases are functional and the most common clinical manifestation is Cushing's syndrome with a progressive course. The only treatment is surgical removal of the entire tumor and effec-tiveness of medical treatments, including mitotane and chemotherapy for survival is still questionable.

Case Report: A 36-year-old man with progressive muscle weakness, high blood pressure, and sudden heart failure is presented. In laboratory tests, hypokalemia, hyperglycemia, increased cortisol, increased serum estradiol and DHEAS were observed. There were an adrenal mass and multiple lung and liver metastases on imaging studies and CT-guided biopsy confirmed adrenal tumor.

Conclusion: High serum concentrations of estradiol and cortisol appear to be effective on heart involvement and acute onset of diabetes, hypertension, and severe heart failure require more evaluations in young adults.