Androgen Secreting Adrenal Adenoma – A Case report

Abstract not available 
Northern International Medical College Journal Vol.10(1) Jul 2018: 355-356

CT scan of KUB Calcified left adrenal mass (5.5 x 3.2cm) and no distant metastasis (lung, liver) was noted Pure androgen-secreting adrenal tumors are very rare and their diagnosis represents a clinical challenge.Virilization is characterized by clitorimegaly, hirsutism, male pattern baldness and deepening of the voice. 2

Case Summary
A 22 months old girl presented with enlargement of clitoris for one year, pubic hair and excessive body hair for 4 months.She had muscular build, her weight was 14 kg, on 90 th centile, height was 86 cm, on 95 th centile and normotensive (Fig1).

Case Report
Androgen Secreting Adrenal Adenoma -A Case report S Begum et al.
Cordera et al. reported hypertension was found in 30% of his 11 cases, testosterone level was elevated in 6 cases and DHEAs was elevated in 5 patients. 5In our patient blood pressure was normal and testosterone was high.
Our patient presented with puberchy at the age of 10 months.Premature pubarchy in children under four years of age be considered as a feature of ACT until proven otherwise. 1 the Curitiba series, the height and weight of the children with ACT often exceeded the 50th percentile at the time of diagnosis. 1Bone age was advanced more than 1 year in 68% of the patients. 7In our patient weight was on 90th centile, height were on 95 th centile and bone age was advanced.Histopathological examination following adrenalectomy is required for diagnosis.The overall prognosis of adrenal adenoma is excellent, in contrast to adrenal cortical carcinoma. 8.68cm x 0.76cm) (Lt ovary-1.42cmx 0.79cm x 1.18cm) normal for age of this child.
A left Adrenalectomy was performed, excision of whole mass (4 X 3 X 1.4 CM) was done and no extension to surrounding lymph node or structure was detected.
Histopathology report showed an encapsulated tumor, mixed architecture of zona fasciculata and zona reticularis, the tumor was composed of cells mostly having granular cytoplasm mixed with cells with clear cytoplasm arranged in trabeculae and nests and some of these cells have mild to moderate nuclear pleomorphism (Fig 4).Foci of infarction and dystrophic calcification are also seen and no vascular or capsular invasion was seen.Adrenocortical adenoma was diagnosed.

Discussion
Our female patient began to develop her symptoms at 10 months of age which was consistent with this study of Michalkiewicz et al. 1 ACT most commonly presented with the signs of virilization and/or hypercortisolism (Cushingoid features).Signs and symptoms of virilization were the most common presenting clinical manifestation (>80% of patients). 3Our case presented with features of virilization.About 89.5% from different case series presented with signs of virilization with or without Cushingoid features. 1,4,5reno et al. described 21 cases with pure androgen-secreting adrenal tumors among them only 2.4% were due to pure androgen-secreting adrenal tumors in which hirsutism was found in all patients.Tumor size had a mean of 9 cm in the adenomas and DHEAs were elevated in virtually every patient. 7In our patient tumor size was 4cm and DHEAs was high.

Fig 2
Fig 2 : Bone age Fig 3: CT scan showed calcified was 5 year left adrenal mas

Fig 4 :
Fig 4: Histopathological slide One month after surgery the S. DHEAs and S. testosterone were normalized and clinical signs receded.

Dr.
Suraiya Begum, Associate professor of Paediatrics, Head of the wing of Paediatric Endocrinology Department of Paediatrics, Bangabandhu Shiekh Mujib Medical University (BSMMU).Obtained her MBBS from Dhaka Medical College in 1983, Diploma in Child Health from Dhaka University in 1997 and Fellowship in Paediatrics from the Bangladesh College of Physician and Surgeons in January 2005.She has been teaching paediatrics for both undergraduate and postgraduate medical students.Training in Paediatric Endocrinology in IPGMR, Chandigarh, India.Established Paediatric Endocrinology in BSMMU.Published 30 research papers, both in national and international journals.Member of Paediatric Endocrine Society of Bangladesh and Indian Society for Pediatric and Adolescent Endrocrinology.