title: Infantile acne as the initial sign of an adrenocortical tumor.
abstract: A 23-month-old boy with persistent acne since 6 months of age had signs of virilization and accelerated growth. Hormone evaluation indicated increased levels of dehydroepiandrosterone (DHEA) and testosterone. Ultrasound and abdominal computed tomographic scan revealed a large adrenal mass consistent with an adrenocortical tumor. The patient underwent surgical excision of the well-encapsulated tumor with normalization of his hormones and no subsequent recurrence. Although rare, childhood adrenocortical tumors have a poor prognosis, with the majority of tumors having regional and metastatic disease. Because early diagnosis and complete surgical excision improve prognosis, children with refractory infantile acne should be evaluated for signs of virilization and accelerated growth. Laboratory evaluation should include luteinizing hormone, follicle-stimulating hormone, total and free testosterone cortisol, DHEA, and its sulfate (DHEA-S). Elevated levels of DHEA and DHEA-S should prompt an aggressive diagnostic evaluation for an adrenocortical tumor.
authors.affiliation: Department of Internal Medicine, Division of Dermatology, Washington University School of Medicine, St Louis, Missouri 63110, USA.
authors.forename: Margaret Wing-Yan
authors.initials: MW
authors.lastname: Mann
authors.forename: Susan Schroeder
authors.initials: SS
authors.lastname: Ellis
authors.forename: Susan Bayliss
authors.initials: SB
authors.lastname: Mallory
mesh_terms: D000152:Acne Vulgaris / Q000209:etiology*; D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D018246:Adrenocortical Adenoma / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003687:Dehydroepiandrosterone / Q000097:blood; D006197:Hair / Q000254:growth & development; D006801:Humans; D007223:Infant; D008297:Male; D010413:Penis / Q000254:growth & development; D013739:Testosterone / Q000097:blood; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D013739:Testosterone; D003687:Dehydroepiandrosterone