Abstract: Objective: To analyze the treatment and prognosis of primary adrenal cortical adeno-carcinoma. Methods: Clinical data of 21 cases with primary adrenal cortical adenocarcinoma were re-viewed. Of the 21 patients, 14 were male and 7 were female, with an mean age of 45.6. The tumor wason the right side in 16 and on the left in 5. The diameter of the tumor was 4 to 28cm. The tumors in thirteen cases were functional with excess hormone production and 8 were nonfunctional. Six cases hadthe evidence of adjacent tissue or lymph nodes invasion. Metastasis occurred in 3 cases. 15 of them re-ceived radical curative resection, 4 received palliative operation and 2 biopsy only. Results: All the cases were followed up 1 to 5 years. The 2-year survival was 52.4% (11/21) and 5-year 23.8%(5/21).Conclusion: Adrenal cortical carcinoma appears to be poor prognosis. Diagnosis of adrenocortical car-cinoma at early stage and the complete resection of tumor is potentially the curative treatment.