Adrenal Cortical Carcinoma in a Male With Excess Gonadotropin in the Urine

TUMORS of the adrenal cortex with symptoms of hypercorticoidism are infrequent (1–3). Most of the cases reported presented masculinization (in females) or the adrenogenital syndrome (in males or females); a few showed evidence of feminization (in males) (4–12). Adrenal cortical tumors associated with excess gonadotropin seem to be exceedingly rare. A search through the literature revealed only one case (McFadzean) (13): The 29-year-old patient was admitted because of unexplained fever. He gave a history of symptomless breast enlargement of eighteen months′ duration, of weight gain of one year's duration, and of decreased sexual activity and libido of six months′ duration. A large tumor mass was palpable in the upper left quadrant. The breasts were well developed, the genitalia were normal, and there was a slight feminine distribution of his hair. X-ray examination showed a soft tissue mass with displacement of the left kidney. The lungs were clear. Urinary estrogens or gonadotropins were not assayed, but a Friedman test was positive. Twenty days after successful removal of the tumor, the Friedman test was found to be negative. Sexual interest and activity returned, and by the forty-third postoperative day the beard was thicker and periareolar hair had grown. The tumor was mostly encapsulated, multilobulated and weighed 1420 Gm. It showed fibrous cores, multiple hemorrhages and light gray areas, and one lobe resembled the “classical hypernephroma.” Microscopic examination revealed an adenocarcinoma, the structure resembling that of adrenal cortex with various types of nuclei and some vacuolization.