Adrenocortical carcinoma (ACC) is an uncommon and severe malignancy, particularly in the pediatric population. It often manifests with warning signs of hormonal imbalance, such as hirsutism and precocious puberty. Timely diagnosis is crucial for effective management. We present the case of a 4-year-old female who presented with indications of virilization, including excessive hirsutism, acne, clitoromegaly, and a moon-shaped facial appearance, which raised suspicion of Cushing's disease. An abdominal ultrasound and computed tomography angiography (CTA) were performed, identifying a left suprarenal tumor. Hormonal tests revealed elevated morning cortisol levels and reduced adrenocorticotropic hormone (ACTH) levels. The patient subsequently underwent total adrenalectomy. Histopathological analysis confirmed a diagnosis of low-grade ACC with clear surgical margins. Pediatric ACC requires early detection to prevent invasion into adjacent structures. Careful observation of clinical symptoms, imaging findings, and histopathological features is crucial for accurate identification and appropriate therapy. This report describes a rare case of pediatric ACC presenting with hormonal symptoms. Continued follow-up with laboratory testing, imaging, and symptom monitoring is essential to detect disease progression or recurrence, particularly in younger patients.