A FEMINIZING ADRENAL TUMOR CAUSING GYNECOMASTIA IN A BOY OF FIVE YEARS CONTRASTED WITH A VIRILIZING TUMOR IN A FIVE-YEAR-OLD GIRL

Abstract

A 5-yr.-old boy with marked gynecomastia was found to have an encapsulated adenoma of the adrenal cortex. After removal there was a gradual decrease in the size of the breasts and no evidence of recurrence after 4 yrs. A 5 1/2-year-old girl who had shown rapid virilization over a period of 6 months had an encapsulated tumor of the adrenal cortex. After operation, metastases recurred in the abdomen and the patient died 2 yrs. later. The feminizing tumor and the masculinizing tumor could not be differentiated histologically. In the case of gynecomastia the excretion of 17-ketosteroids was 4 mg. per day and small amts. of estrogen were demonstrated. The patient with virilization excreted 22 mg. of 17-ketosteroids before operation and 124 mg. after the tumor recurred. Less than 1% consisted of the beta fraction. Seventy cases of cortical adrenal tumor occurring in children under 12 yrs. of age have been reviewed and classified according to whether the patients showed masculinization with increased growth and muscular development attributable to excessive androgen or whether they showed obesity and other metabolic disturbances suggestive of excessive production of cortin with or without virilization. There were 53 cases in females, 17 in males. On the basis of this metabolic difference 43 cases were classified as the adrenogenital syndrome and 26 cases were classified as Cushing''s syndrome and there was one case of feminizing tumor, reported by the author. Twelve cases of adrenal tumor causing gynecomastia are tabulated and discussed. Hormonal studies have been made in only 4 cases. In 2 of these large amts. of estrogen were excreted, while in the patient of Scott there were only small amounts of urinary estrogen and large amts. of beta-17-ketosteroids.