title: An inhibin B and estrogen-secreting adrenocortical carcinoma leading to selective FSH suppression.
abstract: OBJECTIVE
  Hormone-secreting adrenocortical tumors are frequently associated with endocrine syndromes. We describe a 30-year-old man who had abdominal pain, a nodule in the right breast and loss of libido. Abdominal magnetic resonance imaging revealed a very large tumor in the right adrenal gland.
  
  
  METHODS
  Hormonal profile disclosed increased levels of estradiol and slightly low testosterone levels. The basal and stimulated LH levels were normal, whereas basal and stimulated FSH levels were totally suppressed. Cortisol and adrenal androgen levels were normal. The unusual finding of selective FSH suppression suggested secretion of inhibin B by the adrenocortical tumor. A very high level of serum inhibin B (405 pg/ml) was demonstrated by ELISA assay. Right adrenalectomy and nephrectomy were performed and the tumor was classified as a malignant tumor (Weiss score: 7.0) and unilateral mastectomy disclosed a lipoma.
  
  
  RESULTS
  One week after surgery, a GnRH-stimulation test disclosed normal basal and stimulated FSH levels and low levels of inhibin B and estradiol. Immunohistochemical analysis with anti-B-inhibin antibody revealed intense staining in the adrenocortical tumor cells. One month after surgery, an abdominal magnetic resonance imaging revealed a local recurrence of the tumor and a second surgery was performed with partial resection of the tumor and the patient died 1 year after the first surgery.
  
  
  CONCLUSIONS
  We herein report the first inhibin B and estradiol-secreting adrenocortical carcinoma. The unusual selective inhibition of FSH secretion should be considered a valuable hormonal finding for the diagnosis of inhibin B-secreting adrenocortical tumors.
authors.affiliation: Laboratório de Hormônios e Genética Molecular LIM/42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. mariafragoso@uol.com.br
authors.forename: Maria Candida Barisson Villares
authors.initials: MC
authors.lastname: Fragoso
authors.forename: Maria Beatriz Fonte
authors.initials: MB
authors.lastname: Kohek
authors.forename: Regina Matsunaga
authors.initials: RM
authors.lastname: Martin
authors.forename: Ana Claudia
authors.initials: AC
authors.lastname: Latronico
authors.forename: Antonio Marmo
authors.initials: AM
authors.lastname: Lucon
authors.forename: Maria Claudia
authors.initials: MC
authors.lastname: Zerbini
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Longui
authors.forename: Berenice Bilharinho
authors.initials: BB
authors.lastname: Mendonca
authors.forename: Sorahia
authors.initials: S
authors.lastname: Domenice
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000378:metabolism / Q000601:surgery; D000328:Adult; D002277:Carcinoma / Q000097:blood* / Q000175:diagnosis / Q000378:metabolism / Q000601:surgery; D015536:Down-Regulation; D004958:Estradiol / Q000097:blood* / Q000378:metabolism; D017809:Fatal Outcome; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D007150:Immunohistochemistry; D007265:Inhibins / Q000097:blood* / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male
chemical_list: C422364:inhibin B; D004958:Estradiol; D007265:Inhibins; D005640:Follicle Stimulating Hormone