Feminizing adrenal tumors: Our experience about three cases
A male patient aged 45 complaining of fatigue, anorexia, decreased libido, and ejaculations consulted in 2009 for an aching gynecomastia. On clinical examination, there was a moderate bilateral gynecomastia [] without galactorrhea.\nHe did not have any sign of cortisol excess. His BMI was equal to 21 kg/m². Systemic blood pressure was normal. Body hair repartition and testis volume were slightly decreased.\nAbdominal ultrasound showed a huge tumor measuring more than 17 cm above the left kidney that was compressed. Computed tomography (CTscan) confirmed the diagnosis of the left adrenal tumor reaching the parietal area, without invasion of adjacent organs [].\nBiological exams showed a sub clinical hyper cortisolism [220 ng/ml (50-250)], that failed to be decreased after 2 mg dexamethasone (40 ng/ml)], hypogonadism with normal FSH and low LH [T = 5.66 nmol/l (n = 8-34), FSH = 1.19 mu/ml (1-10), LH = 0.03 mu/ml (1-9)], and normal prolactin = 225 μUI/ml (n < 454). E2 was very high varying between 304 and 451 pmol/ml (n < 50). DHEA S, 17OHP, and D4Androstenedione (D4A) were high too [respectively, superior to 10.000 ng/ml (n: 1450-3670), 7.79 ng/ml (0.3-3 ng/ml), and 10.3 nmol/l (0.9-6.5)]. He was operated on, and the huge tumor was totally removed [].\nHistological examination described an endocrine tumor with a thick capsule which was infiltrated in some areas. The architecture was trabecular, and alveolar or organized in nests. Tumoral cells were polymorphous with granulated cytoplasm and polymorphous nuclei (round, egg shaped and sometimes huge). Vascular embolisms were present.\nOne month after surgery there were a weight gain, normalization of E2 (12pmol/l) and other parameters such as T (11.4 nmol/ml), D4A (1.64 ng/ml, n = 0.8-3.1), DHEA S [249 ng/ml (n = 133-441)], and 17OHP [2.8 ng/ml (1.5-7.2)]. Cortisol was suppressed by dexamethazone test. Radiological explorations were normal too. Three years later, there is not any relapsing.