Feminizing Adrenocortical Carcinoma Without Gynecomastia

Area of Science:

• Endocrinology
• Oncology
• Pathology

Background:

• Malignant feminizing adrenocortical tumors are rare endocrine neoplasms.
• Estrogen secretion is the hallmark, commonly presenting with gynecomastia.
• This case presents an exception to the typical clinical manifestation.

Observation:

• A 44-year-old man presented with abdominal pain and a large retroperitoneal mass with metastases.
• Pathological examination confirmed adrenal origin with a high Weiss's score.
• Despite high estradiol and 17OH progesterone, gynecomastia and galactorrhea were absent.

Findings:

• The patient exhibited high cortisol, unsuppressed by dexamethasone, indicating adrenal dysfunction.
• Low testosterone levels were noted alongside elevated estrogenic markers.
• Extensive metastases were present in the pleura, lungs, retroperitoneum, and abdomen.

Implications:

• This case underscores the variability in clinical presentation of malignant feminizing adrenocortical tumors.
• It highlights the importance of comprehensive hormone assessment in suspected adrenal neoplasms, even without classic symptoms.
• The findings contribute to understanding the spectrum of endocrine disturbances in advanced adrenocortical carcinoma.