Hypo-androgen adrenocortical oncocytoma: 1 case report and literature review

Abstract

Objective To analysis the clinical features, diagnosis, treatment and prognosis of adrenal eosinophilic tumor with low testosterone levels. Methods The clinical data of a 22 years old male patient with adrenal eosinophilic tumor and low testosterone levels was analyzed. Blood pressure was 151/88 mmHg. The patient got bilateral gynecomastia. His bilateral testicular was soft and became smaller, with short penisr. Endocrine examination results showed: Estradiol 666 pg/ml, Prolactin 19.08 ng/ml, Testosterone 0.18 ng/ml, follicle stimulating hormone <0.2 U/L. The CT showed the mass density of soft tissue in the left adrenal region with diameter 7 cm, which was inhomogeneous and enhanced. There were many small vessels enhanced in the CT arterial phase, and the blood flow in the tumor was abundant. Clinical diagnosis of left adrenal tumor was pheochromocytoma. The patient underwent laparoscopic left adrenal tumor resection. The left adrenal gland was located in the superior pole of the left kidney, and there was an independent supply of the artery. Results Pathological result showed the tumor weigh was 60 g, 7 cm in diameter and brown in section. The tumor cells were arranged in solid nests or acini, with more eosinophilic granules in cytoplasm. The nuclei was round and the nucleoli was located in the center, had clusters of pleomorphic and clustered cells. The tumor was wrapped in a thick fibrous envelope, mainly consisted of eosinophils, granulation tissue. There was no necrosis, mitosis, and vascular invasion. Immunohistochemical staining showed that the expression of CD56 and syn protein was positive. Pathological diagnosis was left adrenal eosinophilic tumor. After 4 months, the blood testosterone levels rose to 3.90 ng/ml, the blood pressure returned to normal(118/75 mmhg). The estradiol(21 pg/ml) was significantly inhibited. The patient began to appear beards and breasts became smaller. There were no signs of clinical or imaging recurrence. After 16 months follow-up, serum testosterone was 4.68 ng/ml and serum estrogen levels dropped to 33 pg/ml. Semen routine showed no sperm. Conclusions The clinical morbidity of functional adrenocortical oncocytoma with low testosterone levels and high estradiol levels is low. The pathological components are mainly eosinophilic granulation tissue. The adrenocortical oncocytoma are rare and preoperative diagnosis is difficult. Clinical manifestation, imaging examination and adrenal biochemistry examination should be considered to determine the localization and qualitative of tumor. Minimally invasive surgery is an effective treatment. The close follow-up after operation is essential. Key words: Adrenal neoplasm; Oncocytoma; Androgen; Sex hormone abnormality