Isolated DHEAS production by an adrenal neoplasm: Clinical, biochemical and pathologic characteristics

Pingle, Srinath‐Reddi; Jalil, Fatima; Millar, Danielle; Malchoff, Carl D.; Ristau, Benjamin T.

doi:10.1016/j.eucr.2020.101148

Cited by 5 publications

(4 citation statements)

References 4 publications

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“…A multi-center survey of AI in Italy revealed DHEA-S levels were decreased in 12 of 24 patients and normal in the rest [16]. The authors found only one non-cancer AI patient with excess DHEA-S production in the literature, i.e., a 57-year-old woman presented with generalized scalp thinning without acne and excessive body hair as a manifestation of excess androgen [17]. Clinical manifestations of modestly excessive androgen in man are imperceptible.…”

Section: Discussionmentioning

confidence: 99%

An adrenal incidentaloma that had appeared to produce dehydroepiandrosterone-sulfate in excess before immunohistochemical study of the tumor

et al. 2023

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Adrenal incidentaloma is a clinically unapparent adrenal mass more than one cm in diameter detected during imaging performed not for adrenal disease. A 34-year-old man was evaluated for AI with a diameter of 3.5 cm in the left adrenal. He was obese with body mass index of 33,9. Blood pressure was 110-120/90 mmHg. The general laboratory tests were unremarkable. An adrenal hormone screening set revealed that ACTH was 6.9 pg/mL, cortisol 14.9 μg/dL, renin activity 0.9 ng/mL/h, aldosterone 79.4 pg/mL, dehydroepiandrosterone-sulfate (DHEA-S) measured on two occasions 5,217 ng/mL and 6,477 ng/mL (gender-and age-adjusted reference values, 1,060-4,640 ng/mL). The levels of metanephrine and normetanephrine were normal. The tumor was thought to produce solely DHEA-S. The excised left adrenal tissue contained a tumor with a diameter of 26 mm and neighboring adrenal tissue. The tumor consisted mostly of acidophil cells without necrosis, capsular or vascular invasion, and mitosis. Immunohistochemical study revealed followings: the cells of the tumors were stained positive for 3β-hydroxysteroid dehydrogenase, and 17α-hydroxylase, and 11β-hydroxylase, weakly positive for DHEA sulphotransferase, and negative for aldosterone synthetase. The atrophy of neighboring tissue was presumably caused by excess cortisol production. Four months after surgery, the cortisol level was 11.2 μg/dL and DHEA-S level 1,462 ng/mL. The tumor is considered to be a cortisol-producing adenoma with modestly excessive DHEA-S production rather than isolated DHEA-S-producing adenoma. Immunohistochemical study of steroidogenic enzymes is a valuable addition to blood hormone measurement to clarify steroid production profile.

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Section: Discussionmentioning

confidence: 99%

An adrenal incidentaloma that had appeared to produce dehydroepiandrosterone-sulfate in excess before immunohistochemical study of the tumor

et al. 2023

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“…Androgen-secreting adrenal tumors often produce multiple androgens, although there are documented cases of adrenal tumors producing only one androgen. Pingle et al described a case of a purely DHEAS-secreting adrenal neoplasm ( 9 ). Moreno et al had a case series of 21 androgen-secreting adrenal tumors in women; of the 14 with hormonal testing, all had elevated testosterone, only 1 did not have elevated androstenedione, while 4 did not have elevated DHEAS and 3 did not have elevated DHEA ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

A Large Benign Adrenocortical Adenoma Cosecreting Testosterone and Cortisol

Dillon,

Shteyman,

Rabiehashemi

et al. 2024

JCEM Case Reports

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Most adrenal incidentalomas are benign neoplasms of the adrenal cortex. While the majority are nonfunctional, many secrete cortisol. Androgen- or estrogen-secreting adenomas are rare. A 44-year-old female, with history of hypertension and prediabetes, presented with worsening acne, hirsutism, secondary amenorrhea for 2 years, and a 40-pound weight gain. Laboratory evaluation showed high 24-hour urine free cortisol, suppressed adrenocorticotropic hormone (ACTH) level, indicative of ACTH independent Cushing syndrome, and elevated testosterone and androstenedione. Abdominal computed tomography (CT) revealed a 6.3 × 5.2 × 5.6 cm left adrenal mass. Patient underwent left open adrenalectomy. Pathology revealed benign adrenocortical adenoma. Postoperatively there was a significant improvement in her blood pressure and blood sugar levels, resumption of menses, and complete resolution of hyperandrogenism and hypercortisolism. We describe a patient with an adrenal adenoma cosecreting cortisol and androgen, leading to Cushing syndrome and significant virilization. Adrenal masses secreting androgens are less common and concerning for adrenocortical carcinoma (ACC). Patients with adrenal masses cosecreting multiple hormones should undergo workup expediently since ACC confers poor outcomes.

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“…Vast majority >90 % of adrenal neoplasms are benign non-functional adenomas [ 4 ].About 10 % of pheochromocytomas are malignant and 10 % of cases are found on both sides. Additionally, approximately 40 % of pheochromocytomas are caused by genetic factors and can be associated with inherited syndromes [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Cushing syndrome results from hypercortisolism and is characterized by hypertension, weight gain, easy bruising, and central obesity [ 4 ]. Cushing's disease refers to ACTH-dependent cortisol excess caused by a pituitary adenoma, while ACTH-independent cortisol excess due to non-pituitary causes such as excess use of glucocorticoids, adrenal adenoma, hyperplasia, or carcinoma is referred to as Cushing syndrome [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Asymptomatic pheochromocytoma associated with MEN syndrome and subclinical Cushing's syndrome

Shah

Tiwari

Acharya

2023

International Journal of Surgery Case Reports

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Isolated DHEAS production by an adrenal neoplasm: Clinical, biochemical and pathologic characteristics

Cited by 5 publications

References 4 publications

An adrenal incidentaloma that had appeared to produce dehydroepiandrosterone-sulfate in excess before immunohistochemical study of the tumor

An adrenal incidentaloma that had appeared to produce dehydroepiandrosterone-sulfate in excess before immunohistochemical study of the tumor

A Large Benign Adrenocortical Adenoma Cosecreting Testosterone and Cortisol

Asymptomatic pheochromocytoma associated with MEN syndrome and subclinical Cushing's syndrome

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