A case study of virilizing adrenal tumor in an adolescent female elite tennis player--insight into the use of anabolic steroids in young athletes.
A 14-year-old Caucasian girl was referred to the endocrine clinic for evaluation of voice deepening, facial hirsutism, and acne starting 2 years previously. She had been a competitive tennis player since age 7 years, practicing for 4-6 hours daily. On physical examination she was noticed to have a masculine appearance with mild facial acne and moderate hirsutism. Tanner stage was 1 for breast tissue and 5 for pubic hair. Her androgen levels (testosterone, androstenedione, dehydroepiandrosterone sulfate) were extremely elevated. Adrenal ultrasonography revealed a round left 4.6 × 5.3-cm adrenal mass. Laparoscopic left adrenalectomy was performed. The histologic findings were compatible with a benign adrenocortical tumor. Postoperatively, androgen levels dropped to within the normal range. Breast development proceeded normally, menarche occurred 2 months after tumor resection, and menses has been regular since then. Muscle strength of the dominant and nondominant upper and lower extremities was measured 1 month before surgery and 1 year later, using an isokinetic dynamometer (Biodex Systems II, Biodex, Shirley, NY, USA). There was no significant decrease in overall muscle strength after removal of the virilizing tumor and the marked drop in circulating androgens. In addition, the patient maintained her age category, number 1, national tennis ranking. The results suggest that even extremely high levels of tumor-related circulating androgens had no evident effect on muscle strength and competitive performance in a female adolescent tennis player. The lack of beneficial effect on performance in adolescents, combined with the potentially hazardous side effects of anabolic steroids, suggests that teenage athletes should avoid their use.
Child Health and Sports Center, Pediatric Endocrine Clinic, Meir Medical Center, Kfar-Saba, Israel. eliakim.alon@clalit.org.il
Alon
A
Eliakim
Mia
M
Cale-Benzoor
Beatrice
B
Klinger-Cantor
Enrique
E
Freud
Dan
D
Nemet
Elad
E
Feigin
Neomi
N
Weintrob
D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D000315:Adrenalectomy; D045930:Anabolic Agents / Q000009:adverse effects* / Q000378:metabolism; D000735:Androstenedione / Q000097:blood; D001066:Appetite / Q000502:physiology; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D005260:Female; D006801:Humans; D007557:Israel; D053580:Muscle Strength / Q000502:physiology; D010807:Physical Endurance / Q000502:physiology; D055070:Resistance Training; D013715:Tennis; D013739:Testosterone / Q000097:blood; D014463:Ultrasonography; D014770:Virilism / Q000503:physiopathology* / Q000601:surgery
D045930:Anabolic Agents; D013739:Testosterone; D000735:Androstenedione; D019314:Dehydroepiandrosterone Sulfate