Estrogen-secreting adrenal tumor responsive to ACTH: localization by adrenal venous sampling

Feminizing adrenal tumors: Our experience about three cases

Feminizing adrenal tumors (FATs) are very rare as they account for less than 2% of all the adrenal neoplasms. Their prognosis is deemed to be very poor. We aimed to present a mono centre (adult and pediatric) experience over a long period of time (January 1980 to Jun 2012). During the study period, we observed only three cases in men aged 22 (2 cases) and 45 (1 case). They all consulted for a painful gynecomastia, decreased libido and impotency. Estradiol was high in two cases at presentation, and after a relapsing tumor in the third one. All had big adrenal tumors (5.9, 6, and 17 cm), and a mixed secretion composed by high estradiol and cortisol. The pathological study argued for malignancy in two cases. But, only one had diffuse metastasis and died 4 years after diagnosis; the others diagnosed one and three years ago are still alive without any metastasis or relapsing.

Trilostane treatment of bilateral adrenal enlargement and excessive sex steroid hormone production in a cat

A 14-year-old neutered female cat was presented for the investigation of aggression and male-type behaviour. Bilateral adrenal enlargement together with elevated plasma concentrations of oestradiol and testosterone were identified, with no evidence of hypercortisolaemia. These findings are similar to the syndrome of hyperadrenocorticism recognised most commonly in ferrets. The cat was treated for six months with the enzyme inhibitor drug, trilostane, and showed a moderate improvement in clinical signs.

Dexamethasone-suppressible feminizing adrenal adenoma

A 39 year old man presented with gynaecomastia, loss of libido and high blood pressure. Hormone studies revealed elevated plasma levels of oestradiol and its precursors, which increased in response to adrenocorticotrophic hormone and were reduced to normal levels with dexamethasone. Computed tomography disclosed a left adrenal mass and surgery was performed. The removed tumour weighed 84 g and the histological diagnosis was of adenoma. Nine years after surgery, he is asymptomatic, without hypertension, and radiological and or hormonal evidence of recurrence. We discuss the hormone profile in this case and the dynamics of steroid production by the tumour which, in contrast to the classical concept of tumour autonomy, showed dependence of oestradiol secretion on endogenous adrenocorticotrophic hormone.