Benign tumor leads to Cushing’s, masculine traits in woman, 44

Tumor in adrenal gland was found to release cortisol, testosterone

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by Andrea Lobo |

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A 44-year-old woman was found to have a hormone-producing tumor in her left adrenal gland, which produced and released both cortisol and testosterone, leading to the onset of Cushing’s syndrome.

The high levels of testosterone produced and released by the tumor also caused her to develop virilization, a condition in which women acquire a series of masculine traits, including body hair growth, head hair loss, and loss of normal menstruation.

She saw her condition improve after her left adrenal gland was surgically removed.

Her case was described a report, ”A Large Benign Adrenocortical Adenoma Cosecreting Testosterone and Cortisol,” published in JCEM Case Reports.

Cushing’s syndrome encompasses conditions driven by high levels of the stress hormone cortisol. It often is caused by a tumor in the brain’s pituitary gland, which produces large amounts of adrenocorticotropic hormone (ACTH), a signaling molecule that controls cortisol production at the adrenal glands. In such cases, the condition is known as Cushing’s disease.

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Adrenal tumors release cortisol and testosterone in very rare cases

Less frequently, benign tumors in the adrenal glands, called adrenocortical adenomas, directly increase cortisol production. These glands, located atop the kidneys, produce and release several hormones that regulate various bodily functions. In very rare cases, adrenal tumors may simultaneously produce and release cortisol and testosterone.

In this report, researchers at the University of Connecticut described the case of a middle-aged woman who had a previous history of hypothyroidism — low levels of thyroid hormones — high blood pressure (hypertension), and prediabetes.

Over the previous two years, she had gained 40 pounds, or about 18 kg, and experienced skin changes, face swelling, hair loss on the head, hair growth in the abdomen, and loss of menstruation.

The initial clinical evaluation revealed hypertension and a high body mass index, which is a measure of body fat that takes into account a person’s weight and height. She also had an accumulation of fatty tissue in the abdomen and other body parts, abdominal stretch marks, and muscle weakness.

Blood tests revealed low ACTH, normal cortisol, and high testosterone levels. Her levels of androstenedione, a testosterone precursor, were also elevated, as were her 24-hour free urinary cortisol levels.

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CT scan shows mass on left adrenal gland

A CT scan showed the presence of a mass in her left adrenal gland, which was surgically removed, along with the entire gland, through a procedure called adrenalectomy. Further tests conducted in the removed gland revealed the tumor was a benign adrenocortical adenoma, with no signs of invasion into nearby tissues or blood vessels.

The patient was discharged and instructed to take prednisone (10 mg twice daily) to prevent adrenal insufficiency — a condition in which the adrenal glands are unable to produce enough of certain hormones. Prednisone was to be gradually reduced and discontinued over the next four months.

During follow-up, the woman’s hypertension and high blood sugar resolved, and she started having regular periods two months after the surgery. She also experienced less hair loss on her head and lost 60 pounds (or about 27 kg).

Hormonal tests performed three months and one year after the surgery showed her cortisol and testosterone levels were within the normal range. Both remained normal four years after she underwent  surgery.

“We describe a 44-year-old female patient with a benign adrenal adenoma [simultaneously producing] cortisol and [testosterone], causing Cushing syndrome and significant virilization,” the researchers wrote.

However, they noted adrenal tumors producing sex hormones are more likely to be malignant instead of benign. Therefore, patients with adrenal masses simultaneously producing multiple hormones should undergo workup expediently since malignant adrenal cortical cancer “confers poor outcomes,” they wrote.