PDF(Pubmed)
Abstract：
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.
摘要：
大多数肾上腺偶发瘤是肾上腺皮质的良性肿瘤。虽然大多数是不起作用的，许多人分泌皮质醇。分泌雄激素或雌激素的腺瘤很少见。一名44岁的女性,有高血压和糖尿病前期病史，出现恶化的痤疮，多毛症,继发性闭经2年,和40磅的体重增加。实验室评估显示24小时尿游离皮质醇高，抑制促肾上腺皮质激素（ACTH）水平，表明ACTH非依赖性库欣综合征，睾丸激素和雄烯二酮升高。腹部计算机断层扫描（CT）显示左侧肾上腺肿块6.3×5.2×5.6cm。患者接受左开放肾上腺切除术。病理提示良性肾上腺皮质腺瘤。术后她的血压和血糖水平有了显著改善，月经恢复,完全解决高雄激素血症和皮质醇血症。我们描述了一个肾上腺腺瘤患者，同时分泌皮质醇和雄激素，导致库欣综合征和严重的男性化。分泌雄激素的肾上腺肿块不太常见，并且与肾上腺皮质癌（ACC）有关。肾上腺肿块同时分泌多种激素的患者应迅速接受检查，因为ACC预后较差。
