FEMINIZATION AS A RESULT OF BOTH PERIPHERAL CONVERSION OF ANDROGENS AND DIRECT ESTROGEN PRODUCTION FROM AN ADRENOCORTICAL CARCINOMA

A 45-year-old man presented with gynecomastia, hypertension and a larg e left adrenal mass. Further evaluation revealed elevated serum concen trations of estrogen, estrone sulfate, androstenedione, dehydroepiandr osterone, dehydroepiandrosterone sulfate, deoxycorticosterone, and ald osterone and increased 24-hour urinary 17-ketosteroid and free cortiso l excretion. Removal of a 10 kg adrenocortical carcinoma led to normal ization of the hormone concentrations and partial resolution of the gy necomastia. There was no clinical evidence of metastases. Incubation o f tumor slices demonstrated that the tumor had an active aromatase and sulfotransferase. We estimated that about half the serum estrone aros e from peripheral conversion of androstenedione. Feminizing adrenocort ical carcinomas are rare and this case is unusual given the lack of cl inical metastases and the probable dual source of estrogen from tumor as well as from the peripheral conversion of tumor-derived androgens.