European Journal of Pediatrics

, Volume 162, Issue 9, pp 623–628 | Cite as

Virilising adrenocortical tumours in children

  • Walter Bonfig
  • Iris Bittmann
  • Susanne Bechtold
  • Birgit Kammer
  • Vera Noelle
  • Sissi Arleth
  • Klemens Raile
  • Hans-Peter Schwarz
Original Paper

Abstract

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. Conclusion: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.

Keywords

Adrenocortical tumour Children Virilisation 

Abbreviations

ACT

adrenocortical tumour

ACTH

adrenocorticotrophic hormone

DHEAS

dihydroepiandrosterone sulphate

17-OHP

17-hydroxyprogesterone

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Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Walter Bonfig
    • 1
  • Iris Bittmann
    • 2
  • Susanne Bechtold
    • 1
  • Birgit Kammer
    • 1
  • Vera Noelle
    • 1
  • Sissi Arleth
    • 1
  • Klemens Raile
    • 1
  • Hans-Peter Schwarz
    • 1
  1. 1.Department of Paediatric Endocrinology and RadiologyUniversity Children's Hospital MunichMunich Germany
  2. 2.Department of PathologyLudwig-Maximilians-UniversityMunich Germany

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