Indian Journal of Endocrine Surgery and Research

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VOLUME 18 , ISSUE 1 ( January-June, 2023 ) > List of Articles

CASE REPORT

A Masculine Twist: Virilization Caused due to Adrenocortical Cancer

Shubhajeet Roy, Timil Suresh, Madhu Kumar

Keywords : Adrenal, Adrenocortical cancer, Open Adrenalectomy, Secondary amenorrhea, Virilization

Citation Information : Roy S, Suresh T, Kumar M. A Masculine Twist: Virilization Caused due to Adrenocortical Cancer. 2023; 18 (1):13-16.

DOI: 10.5005/jp-journals-10088-11212

License: CC BY-NC 4.0

Published Online: 30-06-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Background: Virilization or masculinization is the biological development of adult male characteristics in females. Most of these changes are produced by androgens. Virilization could be associated with either benign or malignant conditions of the ovaries or the adrenal glands. The most common pathology to cause secondary amenorrhea in a woman of reproductive age-group is polycystic ovarian syndrome. Another important differential, especially in women with severe virilization, is androgen-secreting tumors. Case description: This case report is about a 30-year-old female with secondary amenorrhea for 8 years with features of severe virilization. She was found to have an androgen-secreting right adrenal mass and underwent a successful open adrenalectomy. The histopathology revealed an oncocytic variant of adrenocortical cancer. Conclusion: Secondary amenorrhea is also a very common condition seen in women of reproductive age-group, however, when accompanied by severe virilization, it must raise suspicion for the evaluation of other pathologies such as adrenal tumors as adrenocortical carcinoma (ACC) can be life-threatening if not treated at an early stage. Clinical significance: This case report shows the importance of identifying features of virilization in cases of secondary amenorrhea. It describes the hormonal workup of such patients and its management. It also discusses the controversies regarding the adjuvant treatment of adrenocortical cancer and the need to individualize treatment based on resource constraints.


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  1. Gabrilove JL, Seman AT, Sabet R, et al. Virilizing adrenal adenoma with studies on the steroid content of the adrenal venous effluent and a review of the literature. Endocr Rev 1981;2(4):462–470. DOI: 10.1210/edrv-2-4-462.
  2. Fassnacht M, Libé R, Kroiss M, et al. Adrenocortical carcinoma: A clinician's update. Nature Reviews Endocrinology 2011;7(6):323–335. DOI: 10.1038/nrendo.2010.235.
  3. Lord M, Sahni M. Secondary amenorrhea. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2023. PMID: 28613709.
  4. McKenna TJ. Screening for sinister causes of hirsutism. N Engl J Med 1994;331(15):1015–1016. DOI: 10.1056/NEJM199410133311510.
  5. Derksen J, Nagesser SK, Meinders AE, et al. Identification of virilizing adrenal tumors in hirsute women. N Engl J Med 1994;331(15):968–973. DOI: 10.1056/NEJM199410133311502.
  6. Cavlan D, Bharwani N, Grossman A. Androgen- and estrogen-secreting adrenal cancers. Semin Oncol 2010;37(6):638–648. DOI: 10.1053/j.seminoncol.2010.10.016.
  7. Torti JF, Correa R. Adrenal cancer. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2022; PMID: 31536189.
  8. Mete O, Erickson LA, Juhlin CC, et al. Overview of the 2022 WHO classification of adrenal cortical tumors. Endocr Pathol 2022;33(1):155–196. DOI: 10.1007/s12022-022-09710-8.
  9. Assié G, Letouzé E, Fassnacht M, et al. Integrated genomic characterization of adrenocortical carcinoma. Nat Genet 2014;46(6):607–612. DOI: 10.1038/ng.2953.
  10. Ng L, Libertino JM. Adrenocortical carcinoma: Diagnosis, evaluation and treatment. J Urol 2003;169(1):5–11. DOI: 10.1016/S0022-5347(05)64023-2.
  11. Wong DD, Spagnolo DV, Bisceglia M, et al. Oncocytic adrenocortical neoplasms: A clinicopathologic study of 13 new cases emphasizing the importance of their recognition. Hum Pathol 2011;42(4):489–499. PMID: 21237489.
  12. Luigi M, Rachele D S, Elisabetta C, et al. Adrenal oncocytic neoplasm: A systematic review. Urol Int 2013;91(2):125–133. DOI: 10.1159/000345141.
  13. Fassnacht M, Dekkers OM, Else T, et al. European Journal of Endocrinology European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol 2018;179(4):G1–G46. DOI: 10.1530/EJE-18-0608.
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