Endocrine Abstracts

Adrenocortical tumorigenesis has been observed in mice. It is speculated to be gonadotropin dependent. In particular LH receptors appear to be found within such adrenal tumors in high density and elevated LH levels may be related to adrenal tumorigenesis. The aim was to describe the case of a patient who after ovariectomy developed a large malignant adrenal tumor. A patient, female, aged 42 presented with uterine leiomyomas. She was treated by surgical excision of the uterus along with ovariectomy. Subsequently, she refused to be treated with estrogens, developing however severe postmenopausal symptoms. At the age of 50 she presented with musculoskeletal symptoms affecting the spine, both knees and the left shoulder. A CT scan of the abdomen was performed showing a large mass originating from the left adrenal gland. An MRI was performed and the patient was treated by left adrenalectomy. The adrenal tumor was malignant, measuring 6×6×5 cm, androgen receptor positive and progesterone receptor positive in some areas. The patient recovered. On follow up 6 months later she was free of any malignant disease. She developed Hashimoto’s thyroiditis, antithyroglobulin antibodies being 425 IU/ml (normal values <115 IU/ml) and antimicrosomal antibodies being 213 IU/ml (normal values <34 IU/ml), while TSH was 3.9 IU/L (0.3–4.2 IU/L). In conclusion, the case of a patient is presented who developed a large adrenal tumor following ovariectomy. Adrenal tumorigenesis has been observed in mice following ovariectomy. It is believed to be related to LH stimulation by elevated LH levels, LH receptors having been observed within the adrenal tumors. In mice tumorigenesis may be prevented by the administration of agents lowering gonadotropin levels (Rahman et al, Reprod Biol 2001). It may be that in such cases of premature ovarian failure following surgical ovariectomy, thought should be given to possible treatment aiming at low gonadotropin levels.