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Feminization as a result of both peripheral conversion of androgens and direct estrogen production from an adrenocortical carcinoma

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Abstract

A 45-year-old man presented with gynecomastia, hypertension and a large left adrenal mass. Further evaluation revealed elevated serum concentrations of estrogen, estrone sulfate, androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate, deoxycorticosterone, and aldosterone and increased 24-hour urinary 17-ketosteroid and free cortisol excretion. Removal of a 10 kg adrenocortical carcinoma led to normalization of the hormone concentrations and partial resolution of the gynecomastia. There was no clinical evidence of metastases. Incubation of tumor slices demonstrated that the tumor had an active aromatase and sulfotransferase. We estimated that about half the serum estrone arose from peripheral conversion of androstenedione. Feminizing adrenocortical carcinomas are rare and this case is unusual given the lack of clinical metastases and the probable dual source of estrogen from tumor as well as from the peripheral conversion of tumor-derived androgens.

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Authors and Affiliations

  1. Division of Endocrinology and Departments of Medicine, University of Massachusetts Medical School, 119 Belmont St., Worcester, Massachusetts, 01605, USA

    A. Zayed, J. L. Stock M.D. & M. K. Liepman

  2. Division of Urology Medical Center of Central Massachusetts, University of Massachusetts Medical School, Worcester, Massachusetts, USA

    M. Wollin

  3. Departments of Obstetrics and Gynecology and Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA

    C. Longcope

Authors
  1. A. Zayed
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  2. J. L. Stock M.D.
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  3. M. K. Liepman
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  4. M. Wollin
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  5. C. Longcope
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Zayed, A., Stock, J.L., Liepman, M.K. et al. Feminization as a result of both peripheral conversion of androgens and direct estrogen production from an adrenocortical carcinoma. J Endocrinol Invest 17, 275–278 (1994). https://doi.org/10.1007/BF03348975

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  • DOI: https://doi.org/10.1007/BF03348975

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