Feminizing Adrenal Tumour - A Case Series from a Tertiary Care Centre in Northern India

Benign adrenal tumours are frequently seen in endocrinology, affecting mostly men in middle aged. But incidentalomas are more common in the elderly. Functional adrenal tumours most commonly secrete cortisol, aldosterone and very rarely, oestrogen. But if mixed secretion is present (most commonly cortisol and androgen), it is prudent to suspect adrenal cortical carcinoma (ACC), which in fact is rare < 5% of all adrenal tumours. ACC-secreting estradiol is rarer, 1-2% of all adrenal tumours. Most feminizing adrenal tumours (FATs) are malignant with a very poor prognosis.

The study was a retrospective observational study conducted between January 2013-December 2023. Data was retrieved from the hospital information system.

Out of 156 patient profiles screened for adrenal tumours, four were selected for analysis who had elevated estradiol levels. The mean age was 45 years, with all being males. Two patients had ACC and two had benign tumours. All four had painless gynaecomastia. Three patients had mild autonomous cortisol secretion (MACS) with worsening of diabetes, hypertension, and osteopenia. Estradiol levels were ranging from 301 to 3648 pmol/L. CT abdomen showed average size of tumour being 10.7 cm. Two patients had distant metastases to lung, liver, and bone. All underwent adrenalectomy, and one of them received post-adjuvant chemotherapy. Patients with ACC had Weiss score of 6. Postoperatively, two patients had decreased estradiol.

FATs are very rare in endocrinology, with most of them being ACC with a dire prognosis. Even with early diagnosis and treatment, the short-term survival is very poor.