Feminizing Adrenocortical Tumors as a Rare Etiology of Isosexual/Contrasexual Pseudopuberty

Abstract

Objective: Estrogen-secreting adrenocortical tumors (ACTs) are quite rare with feminizing adrenocortical tumors (FATs) accounting for 0.37-2% of all ACTs. The aim was to evaluate clinical and hormonal characteristics of FATS as well as treatment options and follow-up in the pediatric age group. Methods: Medical records of children with ACTs presenting to a single center in the last two decades were reviewed. Literature review within Pubmed revealed 34 pediatric patients (22 boys) with FAT among 192 articles. Results: Among the 25 children presenting with ACTs in the last two decades, two new pediatric cases of FAT were identified, one benign and the other malignant, in two genders with different clinical presentations. Literature review showed that FATs are extremely rare tumors that are most commonly seen in men and boys presenting with gynecomastia. FATs are more common in children ≤8 years of age, with a median age at diagnosis of six years. While boys present with contrasexual pseudopuberty signs, girls present with isosexual pseudopuberty. A high estrogen level strongly supports diagnosis, while elevations in other adrenal hormones may be seen. FATs are usually malignant in adults and prognosis is generally very poor. However, in children approximately half are benign although assessment of malignant potential depends on clinical behavior of the tumor. FATs are very unpredictable so even after surgery long-term follow-up is required. FATs presenting in childhood may have a better prognosis than adult presentation tumors as most FATs in children are followed without recurrence of tumor. Conclusion: FATs are more common in children ≤8 years of age, with a median age at diagnosis of six years. FATs in childhood may have a better prognosis than in adult males.

Macropenis in a Toddler

“…Hormone secretion is usually mixed; androgen, cortisol, aldosterone, and rarely estrogen secretion may be excessive. [3][4][5] Both androgen and cortisol hypersecretion are associated with half of the functional tumors. Pure androgen-secreting adrenocortical tumors (PASATs) are rare.…”

Feminizing Adrenocortical Tumor with Multiple Recurrences: A Case Report

“…These are most commonly seen in adult males. Presenting signs/symptoms in adult males commonly include gynecomastia, hypogonadism, and weight fluctuation (either loss or gain, with loss being more common); in adult females, there is irregular or postmenopausal bleeding; in pediatric males, there is contrasexual precocious pseudopuberty; and in pediatric females, there is isosexual precocious puberty [ 5 ]. In pure FATs, there is usually a lack of signs or symptoms of Cushing syndrome, hypertension, and virilization/hirsutism, differentiating FATs from mixed functional adrenocortical tumors.…”