Feminizing adrenal tumors: Our experience about three cases
A male patient aged 22 consulted for the first time on February 1983 for recent breast enlargement with back pain, decreased libido, and erectile troubles. Clinical examination was normal except for mild gynecomastia. Hormonal exploration done by his family physician showed normal prolactin (PRL)=5.9ng/ml (n=5-10), low testosterone (T)=2ng/ml (n=2-9), normal folliculostimulating hormone (FSH)=4.3mu/ml (n=2-9), normal luteostimulating hormone (LH)=9.2mu/ml (n=2-11) and normal estradiol (E2)=30pg/ml (n=10-40). Radiological exams argued for a left adrenal tumor measuring 6 cm in height. Unfortunately, cortisol assessment was not done. After surgery, histological examination confirmed the adrenal origin and argued for a malignant one with a small metastasis in the homolateral kidney. Two months later, cortisol assessment was normal (70ng/ml, n = 50-250), but E2 and dehydroepiandrosterone sulphate (DHEA S) were in the pathological ranges [respectively, 66.9 pg/ml (n < 40) and 3.2 ng/ml (n = 0.5-2.5)], then a small polylobulated tumor appeared in the liver. Eighteen months later, mean cortisol was slightly elevated (279 ng/ml), but was suppressed by 2 mg dexamethazone (18 ng/ml), the corticotrophin hormone (ACTH) was undetectable, E2 was high (346 pg/ml), so were plasma 17-hydroxy progesterone (17OHP): 11.46 ng/ml (n = 0.5-2.5), and DHEA S (6.34). Numerous metastases were present in the liver, chest, right adrenal, and bones []. Abdomen lymph nodes were involved too. He died 4 years after the first symptoms, as OP’DDD was not available and classical chemotherapy was inoperative.