Virilising adrenocortical tumours in children.
Adrenocortical tumours (ACT) are a rare but important cause of virilisation in infancy and childhood. Four cases of virilising ACT are presented. Two girls (age 0.9 years and 3.9 years) and two boys (age 6.2 years and 6.4 years) had symptoms and signs of virilisation before the age of 6 years. Diagnosis of a virilising adrenal tumour was confirmed by laboratory tests, diagnostic imaging and histology. However, one female patient was misdiagnosed and treated for 3 months as atypical congenital adrenal hyperplasia. Ultrasonography of the adrenal region could not visualise the tumour in three out of four cases. The most sensitive method of diagnostic imaging was MRI. In all cases, treatment consisted of complete surgical resection of the adrenal tumour by open abdominal surgery. Immunohistochemistry was performed in all patients and in two patients there was an overexpression of p53, indicating p53 mutation and in three cases the ki67 proliferation index was greater than 5%. The classification of ACT in childhood is extremely difficult. Histology scores adapted from adrenal tumours in adults and molecular markers are under investigation, but there is still not enough clinical experience since ACT are so rare.


CONCLUSIONS
Long-term follow-up is mandatory not only because of the uncertainty in classification of adrenocortical tumours, but also for observation of growth and pubertal development.
Bonfig
Walter
W
Department of Paediatric Endocrinology and Radiology, University Children's Hospital Munich, Lindwurmstrasse 4, 80337 Munich, Germany. wbonfig@web.de
Bittmann
Iris
I
Bechtold
Susanne
S
Kammer
Birgit
B
Noelle
Vera
V
Arleth
Sissi
S
Raile
Klemens
K
Schwarz
Hans-Peter
HP
D015065:17-Hydroxycorticosteroids / Q000097:blood / Q000652:urine; D000306:Adrenal Cortex Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000378:metabolism; D000312:Adrenal Hyperplasia, Congenital / Q000175:diagnosis / Q000378:metabolism; D018246:Adrenocortical Adenoma / Q000145:classification / Q000175:diagnosis* / Q000378:metabolism; D018268:Adrenocortical Carcinoma / Q000145:classification / Q000175:diagnosis* / Q000378:metabolism; D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000652:urine; D000735:Androstenedione / Q000097:blood / Q000652:urine; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002648:Child; D002675:Child, Preschool; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood / Q000652:urine; D003951:Diagnostic Errors; D018450:Disease Progression; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D019394:Ki-67 Antigen / Q000235:genetics / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D009154:Mutation / Q000235:genetics; D013739:Testosterone / Q000097:blood / Q000652:urine; D014057:Tomography, X-Ray Computed; D016159:Tumor Suppressor Protein p53 / Q000096:biosynthesis / Q000235:genetics; D018084:Ultrasonography, Interventional; D014770:Virilism / Q000145:classification / Q000175:diagnosis* / Q000378:metabolism
D015065:17-Hydroxycorticosteroids; D015415:Biomarkers; D019394:Ki-67 Antigen; D016159:Tumor Suppressor Protein p53; D013739:Testosterone; D000735:Androstenedione; D019314:Dehydroepiandrosterone Sulfate; D000324:Adrenocorticotropic Hormone