Background/ObjectiveTo describe a case highlighting a rare malignancy that can be camouflaged by the hormonal milieu of pregnancy.Case ReportWe present the case of a 28-year-old pregnant female who was diagnosed with stage IV metastatic adrenocortical carcinoma at 15-weeks gestation. The patient declined palliative chemotherapy at first with the hope of continuing her pregnancy. She had elevated dehydroepiandrosterone sulfate, testosterone, and cortisol levels consistent with Cushing’s syndrome and hyperandrogenism. The patient eventually had a spontaneous abortion and elected to start chemotherapy and mitotane treatment. She passed away 3 months after initial presentation.DiscussionAdrenocortical carcinoma is difficult to detect and diagnose in pregnant patients because of the physiologic hormonal changes that take place during gestation. The patient described in this case report is an example of this diagnostic challenge.ConclusionAdrenocortical carcinoma is a rare, fatal disease that often presents at an advanced stage with limited treatment options making earlier diagnosis imperative; however, diagnosis and treatment are complicated by pregnancy. More data is necessary to determine how best to approach these challenges in future patients.