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Endocrine Abstracts (2006) 11 P121

University Hospitals of Leicester, Leicester, United Kingdom.


Adrenocortical carcinoma is extremely rare and accounts for 0.05–2% of all malignant neoplasms with an estimated incidence of 0.5–2% per million people per year. Feminising adrenal carcinoma is even rarer. We submit such a rare case presenting with gynaecomastia.

A 50 year old man presented with a year history of increasing bilateral gynaecomastia. He had no problems with his sexual function. Initial investigations by the GP showed low testosterone (4.8 nmol/l) with undetectable LH and FSH, TSH 2.2 mU/l, FT4 15 pmol/l, prolactin 131 & random cortisol 293. Renal function and liver enzymes were normal. It was initially thought that he had secondary hypogonadism but his 17 ß-oestradiol level was elevated at 332 pmol/l (0–130). α-fetoprotein and ß-hCG were normal. Whilst awaiting further review, he went to see his GP complaining of right flank pain. An ultrasound scan showed a large mass in the right flank suggestive of a renal cell carcinoma. A CT scan suggested that the mass was more likely to be of adrenal origin. Further investigations showed normal 24 hour urinary catecholamines, androstenedione level>34 nmol/l (1.0–10.8) and DHEAS 24 nmol/l (2.2–15.7). After a 48 h low dose dexamethasone suppression test, cortisol suppressed to 83 nmol/l, and androstenedione to 5.3 nmol/l but DHEAS showed minimal suppression at 20 nmol/l suggesting a degree of autonomous cortisol secretion by the lesion but demonstrating dexamethasone suppressibility of the markedly elevated androstenedione level.

He proceeded to laparotomy and a 1.2 kg adrenal tumour was removed, measuring 190×110×120 mm. The histology confirmed adrenocortical carcinoma. Androstenedione, DHEAS and 17 ß-oestradiol levels returned to normal post-surgery with improvement of his gynaecomastia. At his last review 2 years after his surgery his hormonal profile was normal with no evidence of recurrence of his tumour. This case illustrates the importance of considering an oestrogen-secreting adrenal tumour in cases of gynaecomastia with suppressed gonadotrophins and low testosterone.

Volume 11

8th European Congress of Endocrinology incorporating the British Endocrine Societies

European Society of Endocrinology 
British Endocrine Societies 

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