Feminizing adrenal tumors: Our experience about three cases
A man, aged 22, consulted in 2011 for bilateral gynecomastia that began 3 years before, with recent fatigue, decreased libido and erections, and reduction in shaving frequency. Clinical examination showed bilateral gynecomastia [stage 2: ] without galactorrhea.\nHe was weighing 68 kg for 1.74 m (BMI = 22.66 kg/m²), blood pressure = 120/80 mm Hg, heart frequency = 74 bt/min and body hair repartition was normal; his penis was pale and measured 5 cm in length. Testes diameters were normal. Abdomen palpation did not find any mass. The rest of physical examination was normal.\nRoutine analyzes were unremarkable. Hormonal assessment showed very high estradiol (1722 pg/ml) with low testosterone (0.47 ng/ml: n = 2.4-8.3), low FSH (<0.1), low LH (0.6) and high 17OHP (26.9 nmol/l; n = 0.9-6.7). Prolactin rate was slightly elevated: 26 ng/ml (normal ranges: n = 4-15). Cortisol was normal, but failed to be suppressed by 2 mg dexamethazone (193 μg/l → 194). DHEA S and androstenedione were not increased (respective values: 361 μg/dl, n = 133-441 and 2.44 ng/ml, n = 0.3-3.1).\nAbdomen and pelvis ultrasounds showed a hypoechoic right adrenal with small calcifications and normal testes measuring 38 × 13.5 mm.\nCT scan confirmed a well-vascularized tumor measuring 59 × 43 × 56 mm situated above the right kidney []. Its spontaneous density was superior to 10 HU with an absolute «Wash out» equal to 60%. Many abdominal lymph nodes were present, but the liver was normal. The left adrenal was normal too.\nChest X-rays, chest CT scan, and body scintigraphy were normal. When he was operated on, the surgeon observed a well-limited, much vascularized mass. The kidney was slightly compressed, but not involved.\nHistological study argued for a benign tumor with a Weiss score equal to 2 and a Ki67 <1%.\nSome months after surgery, the gynecomastia decreased in size and sexual behavior increased, radiological and hormonal exams were normalized, but a moderate systemic high blood pressure appeared. Successive explorations are still normal, but the time is not sufficient to exclude the malignancy.